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Setiawan E, Cassidy-Seyoum SA, Thriemer K, Carvalho N, Devine A. A Systematic Review of Methods for Estimating Productivity Losses due to Illness or Caregiving in Low- and Middle-Income Countries. PHARMACOECONOMICS 2024; 42:865-877. [PMID: 38874846 PMCID: PMC11249595 DOI: 10.1007/s40273-024-01402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Productivity losses are often included in costing studies and economic evaluations to provide a comprehensive understanding of the economic burden of disease. Global guidance on estimating productivity losses is sparse, especially for low-and middle-income countries (LMICs) where informal and unpaid work remains dominant. This study aims to describe current practices for valuing productivity losses in LMICs. METHODS We performed a systematic review of studies published before April 2022 using three databases, including PubMed, Cochrane Library and Web of Science Core Collection. We included any costing or economic evaluation study conducted in a LMIC that provided methodological details on how the monetary value for productivity losses was estimated. Two reviewers independently screened articles for inclusion, extracted data and assessed the quality of the studies. RESULTS A total of 281 articles were included. While most studies did not specify the overall approach used to measure and value productivity losses (58%), the human capital approach was the most frequently used approach to measure productivity losses when this was clearly stated (39%). The most common methods to estimate a monetary value for productivity losses were market wages (51%), self-reported wages (28%) and macroeconomic measures (15%). CONCLUSION Reporting standards for productivity losses in LMIC settings have room for improvement. While market wages were the most frequently used method to estimate the monetary value of productivity losses, this relies on context-specific data availability. Until a consensus is reached on if, when and how to include productivity losses in costing and economic evaluation studies, future studies could include a sensitivity analysis to explore the impact of different methods for estimating the monetary value of productivity losses.
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Affiliation(s)
- Ery Setiawan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sarah A Cassidy-Seyoum
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Ipinnimo TM, Ipinnimo MT, Alabi AK, Buari TH, Ajidahun EO, Olasehinde OK, Ipinnimo OM, Ojo JO. Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria. Ghana Med J 2023; 57:218-225. [PMID: 38957665 PMCID: PMC11216740 DOI: 10.4314/gmj.v57i3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objective To assess and compare how private and public health facilities patients cope with the economic burden of non-communicable diseases. Design Comparative cross-sectional study. Setting Thirty-nine private and eleven public health facilities in Ado-Ekiti, Nigeria. Participants Three hundred and forty-eight (Private:173; Public:175) patients with hypertension or diabetes, or both were recruited. Main Outcome Measures Specific coping methods and numbers of coping strategies used by participants, as well as the perceived ability of participants to cope with the economic burden of non-communicable diseases. Results Majority of participants paid through out-of-pocket (OOP) than through health insurance(HI) (Private:OOP:90.2% HI:9.8%; Public:OOP:94.3% HI:5.7%; p=0.152). More participants in private used instalment payments(p<0.001). However, other coping strategies showed no significant difference in both groups(p>0.05). Delayed treatment (Private:102; Public:95) was the most used strategy in both arms, and the number of strategies used by the participants showed no significant difference(p=0.061). Lower levels of education, out-of-pocket payment, increasing number of clinic visits, and hospital admission were associated with the use of higher numbers of coping strategies in both groups while being female and retired/unemployed were associated with the private arm. Conclusion Although most patients in both groups pay out-of-pocket and use detrimental coping strategies, more patients in private arm use instalment payment, a non-detrimental method. Healthcare providers, especially public providers, should adopt policies encouraging patients to use non-detrimental coping strategies to meet their healthcare expenditures. Funding None declared.
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Affiliation(s)
- Tope M Ipinnimo
- Community Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Ayodele K Alabi
- Community Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Taiwo H Buari
- Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Esther O Ajidahun
- Medicine Department, Wesley Guild Hospital Ilesha Annex, Obafemi Awolowo
- University Teaching Hospital Complex, Ile-Ife, Nigeria
| | | | - Oluwadare M Ipinnimo
- Obstetrics and Gynaecology Department, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - John O Ojo
- Community Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Nigeria
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Odunyemi A, Rahman T, Alam K. Economic burden of non-communicable diseases on households in Nigeria: evidence from the Nigeria living standard survey 2018-19. BMC Public Health 2023; 23:1563. [PMID: 37592334 PMCID: PMC10433548 DOI: 10.1186/s12889-023-16498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The importance of non-communicable diseases (NCDs) in Nigeria is reflected in their growing burden that is fast overtaking that of infectious diseases. As most NCD care is paid for through out-of-pocket (OOP) expenses, and NCDs tend to cause substantial income losses through chronic disabilities, the rising NCD-related health burden may also be economically detrimental. Given the lack of updated national-level evidence on the economic burden of NCDs in Nigeria, this study aims to produce new evidence on the extent of financial hardship experienced by households with NCDs in Nigeria due to OOP expenditure and productivity loss. METHODS This study analysed cross-sectional data from the most recent round (2018-19) of the Nigeria Living Standard Survey (NLSS). Household-level health and consumption data were used to estimate catastrophic health expenditure (CHE) and impoverishing effects due to OOP health spending, using a more equitable method recently developed by the World Health Organization European region in 2018. The productivity loss by individuals with NCDs was also estimated from income and work-time loss data, applying the input-based human capital approach. RESULTS On average, a household with NCDs spent ₦ 122,313.60 or $ 398.52 per year on NCD care, representing 24% of household food expenditure. The study found that OOP on cancer treatment, mental problems, and renal diseases significantly contribute to the cost of NCD care. The OOP expenditure led to catastrophic and impoverishing outcomes for households. The estimations showed that about 30% of households with NCDs experienced CHE in 2018, using the WHO Europe method at the 40% threshold. The study also found that the cost of NCD medications was a significant driver of CHE among NCD-affected households. The results showed heterogeneity in CHE and impoverishment across states and geographical regions in Nigeria, with a higher concentration in rural and North East geopolitical locations. The study also found that 20% of NCD-affected households were impoverished or further impoverished by OOP payment, and another 10% were on the verge of impoverishment. The results showed a negligible rate of unmet needs among households with NCDs. CONCLUSIONS The study highlights the significant effect of NCDs on Nigerian households and the need for effective policy interventions to address this challenge, particularly among the poor and vulnerable.
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Affiliation(s)
- Adelakun Odunyemi
- Murdoch Business School, Murdoch University, 90 South Street, Perth, WA, 6150, Australia.
- Hospitals' Management Board, Akure, Ondo State, Nigeria.
| | - Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
- Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, 90 South Street, Perth, WA, 6150, Australia
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Ipinnimo TM, Emmanuel EE, Ipinnimo MT, Agunbiade KH, Ilesanmi OA. Financial Cost of Hypertension in Urban and Rural Tertiary Health Facilities in Southwest, Nigeria: A Comparative Cross-Sectional Study. Indian J Community Med 2023; 48:340-345. [PMID: 37323733 PMCID: PMC10263046 DOI: 10.4103/ijcm.ijcm_431_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 02/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background The financial cost of hypertension could result in serious economic hardship for patients, their households, and the community. To assess and compare the direct and indirect cost of care for hypertension in urban and rural tertiary health facilities. Material and Methods A comparative cross-sectional study was carried out in two tertiary health facilities which are located in urban and rural communities of the southwest, Nigeria. Four hundred and six (204 urban, 202 rural) hypertensive patients were selected from the health facilities using a systematic sampling technique. A pretested semi-structured, interviewer-administered questionnaire adapted from that used in a previous study was used for data collection. Information on biodata, and direct and indirect costs was collected. Data entry and analysis were done using IBM SPSS Statistics for Windows, Version 22.0. Results More than half of the respondents were females (urban, 54.4%; rural, 53.5%) and in their middle age (45-64 years) (urban, 50.5%; rural, 51.0%). The monthly cost of care for hypertension was significantly higher in urban than in rural tertiary health facilities (urban, 19,703.26 [$54.73]; rural, 18,448.58 [$51.25]) (P < 0.001). There was a significant difference in the direct cost (urban, 15,835.54 [$43.99]; rural, 14,531.68 [$40.37]) (P < 0.001), although the indirect cost (urban, 3,867.72 [$10.74]; rural, 3,916.91 [$10.88]) (P = 0.540) did not show much difference between the groups. The cost of drugs/consumables and investigations contributed more than half (urban, 56.8%; rural, 58.8%) of the cost in both health facilities. Conclusion The financial cost of hypertension was higher in the urban tertiary health facility; therefore, more government support is needed in this health facility to close the financial gap.
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Affiliation(s)
- Tope Michael Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Eyitayo Ebenezer Emmanuel
- Department of Community Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State and Department of Community Medicine, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Ipinnimo TM, Elegbede OE, Durowade KA, Adewoye KR, Ibirongbe DO, Ajayi PO, Sanni TA, Fatunla OAT, Ipinnimo MT, Ibikunle AI. Cost of illness of non-communicable diseases in private and public health facilities in Nigeria: a qualitative and quantitative approach. Pan Afr Med J 2023; 44:6. [PMID: 36818035 PMCID: PMC9935661 DOI: 10.11604/pamj.2023.44.6.35494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction the cost of illness (COI) of non-communicable diseases (NCDs) has detrimental effects on healthcare outcomes in addition to the serious economic impact on patients and their families. This study estimated and compared the COI of NCDs and its predictors in private and public health facilities (HF) in Ado-Ekiti, Nigeria. Methods the study was carried out in selected HF (39 private; 11 public) using a comparative cross-sectional design with a mixed method of data collection. Quantitative data were collected from 348 hypertensive and/or diabetic patients (173 private; 175 public) using a semi-structured, interviewer-administered questionnaire while qualitative data were from 5 key informant interviews (KII) conducted with HF heads or their representatives. Results the average monthly COI of NCDs was higher among patients in private (₦15,750.38±14,286.47 [US$43.75±39.68]) than in public HF (₦13,283.37±16,432.68 [US$ 36.90±45.65]) (P<0.001), however, the indirect cost was higher in public HF (private, ₦1,561.07 [US$4.34]; public, ₦3,739.26 [US$10.39]) (p<0.001). Predictors of COI of NCDs identified were income and admission in both groups. Additionally, age, payment method, type of NCDs, having two or more complications, and exercise were identified in private while socioeconomic status, length of diagnosis, and alcohol were identified in public HF. The KII revealed a long waiting time for the public HF patients which accounted for the huge indirect cost. Conclusion the study found a huge indirect cost in the public HF that could be minimized by developing policies that would reduce the waiting time of patients. Government and private interventions targeting identified predictors should be applied to reduce the financial burden of NCD.
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Affiliation(s)
- Tope Michael Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria,,Corresponding author: Tope Michael Ipinnimo, Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria.
| | - Olusegun Elijah Elegbede
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria,,Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kabir Adekunle Durowade
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria,,Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kayode Rasaq Adewoye
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria,,Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | | | - Paul Oladapo Ajayi
- Department of Community Medicine, Ekiti State University, Ado-Ekiti, Nigeria
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Ipinnimo TM, Adewoye KR, Durowade KA, Elegbede OE, Ojo JO, Dele-Ojo BF, Oluwademilade OJ, Atoyebi OA, Sanni TA, Asake OT, Daramola BW, Fadipe AO. Comparative assessment of health-related quality of life among hypertensive patients attending state and federal government teaching hospitals in Ekiti State, Nigeria. DIALOGUES IN HEALTH 2022; 1:100069. [PMID: 38515920 PMCID: PMC10953898 DOI: 10.1016/j.dialog.2022.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 03/23/2024]
Abstract
Background Hypertension is a serious health problem and it is one of the diseases that impair health-related quality of life. The central tenet of care should be to improve health-related quality of life and overall well-being and not just be limited to improving clinical outcomes. This study assesses and compares health-related quality of life and its predictors among hypertensive patients in two government hospitals in Ekiti State, Nigeria. Methods This was a comparative cross-sectional study involving 440 hypertensive patients (220 in each group), recruited using a systematic sampling technique within the hospitals. Data on socio-demographic, economic and clinical characteristics including the cost of care for hypertension were collected from the patients. The WHOQoL-BREF questionnaire was used to assess health-related quality of life. Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0. Results All domains of health-related quality of life were better among patients in federal government teaching hospitals, however, only the physical (T = -7.932, p < 0.001) and overall (T = -2.783, p = 0.006) domains were of statistical significance. An inverse relationship between cost and health-related quality of life was found in the two hospitals (State: r = -0.224, p = 0.001; Federal: r = -0.378, p < 0.001). Identified predictors of health-related quality of life were age, locality of residence, income, number of complications, exercise and smoking in both hospitals. Other predictors were marital status, living arrangement, occupation, number of medications, and involvement in religious and spiritual activities among patients in the state government teaching hospital; household size, length of diagnosis, and indirect cost among patients in the federal government teaching hospital. Conclusion There is a need to support hypertensive patients in the state government teaching hospitals to reduce the inequality of low health-related quality of life among them. Identified predictors should be taken into consideration when putting in place policies that will improve the health-related quality of life of these patients.
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Affiliation(s)
| | - Kayode Rasaq Adewoye
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kabir Adekunle Durowade
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - Olusegun Elijah Elegbede
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - John Olujide Ojo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | | | - Olarinde Jeffrey Oluwademilade
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
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Ipinnimo TM, Durowade KA. Catastrophic Health Expenditure and Impoverishment from Non-Communicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria. Ethiop J Health Sci 2022; 32:993-1006. [PMID: 36262712 PMCID: PMC9554780 DOI: 10.4314/ejhs.v32i5.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/15/2022] [Indexed: 11/07/2022] Open
Abstract
Background Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. Methods A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per group) selected through multistage sampling. Data were collected with a semi-structured, interviewer-administered questionnaire and analyzed with IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1) and the WHO (CHE2) methodological thresholds. Results The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private health facilities. However, there was no significant difference between the proportion of impoverishment (Private:24.3%, Public:30.9%, p=0.170). The identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted catastrophic health expenditure while the level of education, socioeconomic status and the number of admissions predicted impoverishment in public health facilities. Conclusions Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to limit catastrophic health expenditure and impoverishment among them.
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Affiliation(s)
- Tope Michael Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Kabir Adekunle Durowade
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria and Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
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Tsimicalis A, Gasse M, Morand M, Rauch F. Use of Netnography to Understand GoFundMe® Crowdfunding Profiles Posted for Individuals and Families of Children with Osteogenesis Imperfecta. Healthcare (Basel) 2022; 10:healthcare10081451. [PMID: 36011107 PMCID: PMC9407832 DOI: 10.3390/healthcare10081451] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder associated with low bone density and increased bone fragility. OI can lead to a variety of supportive and medical care needs; yet financial impacts for families and individuals living with OI remain understudied and largely invisible. Efforts by families to recover costs through GoFundMe®, the most important crowdfunding web platform worldwide, offer an unprecedented opportunity to gain insight into OI costs. The purpose of this study was to describe GoFundMe® profiles and determine what factors may contribute to funding goal achievement. A netnographic approach was used to investigate a publicly available dataset from GoFundMe®, with 1206 webpages extracted and 401 included for analysis. Most webpages originated from the United States and were created by family members. Nineteen cost categories were identified. Thirty-seven web profiles met their funding goal. Funding increases or goal achievements created for children were associated with increased social-media exposure (i.e., Facebook). This study helped to describe and showcase the financial impacts of OI and effectiveness of a crowdfunding website to alleviate costs. The results highlight the need for further research to better understand OI costs and provide economic supports for individuals with OI.
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Affiliation(s)
- Argerie Tsimicalis
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada; (M.G.); (M.M.)
- Shriners Hospitals for Children, Montreal, QC H4A 0A9, Canada;
- Correspondence:
| | - Michael Gasse
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada; (M.G.); (M.M.)
| | - Marilyn Morand
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada; (M.G.); (M.M.)
| | - Frank Rauch
- Shriners Hospitals for Children, Montreal, QC H4A 0A9, Canada;
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
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Mishra S, Mohanty SK. Out-of-pocket expenditure and distress financing on institutional delivery in India. Int J Equity Health 2019; 18:99. [PMID: 31238928 PMCID: PMC6593606 DOI: 10.1186/s12939-019-1001-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socio-economic groups. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. DATA Data from the fourth round of National Family Health Survey (NFHS 4), 2015-16 was used for the analysis. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India. RESULTS The OOPE on institutional delivery has strong economic and educational gradient. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. Finding are robust across the states of India. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery. CONCLUSION Distress financing on institutional delivery was higher among the less educated, poor and in private health centers. Increasing use of public health centers, reducing caesarean births, improving the availability of medicine and diagnostic services can reduce the extent of distress financing in India.
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Affiliation(s)
- Suyash Mishra
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088 India
| | - Sanjay K. Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088 India
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