A qualitative inquiry of access to and quality of primary healthcare in seven communities in East and West Africa (SevenCEWA): perspectives of stakeholders, healthcare providers and users

Ameh, Soter; Akeem, Bolarinwa Oladimeji; Ochimana, Caleb; Oluwasanu, Abayomi Olabayo; Mohamed, Shukri F; Okello, Samson; Muhihi, Alfa; Danaei, Goodarz

doi:10.1186/s12875-021-01394-z

Cited by 15 publications

(29 citation statements)

References 34 publications

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“…The provision of functional diagnostic equipment is needed to ensure that no users are asked to finance further investigations out of pocket or purchase drugs from private pharmacies [60]. Drug shortages and lack of diagnostic equipment negatively affected the service availability, with evidence from a number of studies showing that the provision of integrated care and management calls for a clear strategy to support a well organised health system in a supportive political environment for optimal outcomes [23,48,[61][62][63]. As Kasaie, Weir [13] observe, for integration to be successful increased financial commitment is required to support and sustain services, particularly if they are to be delivered at scale.…”

Section: Discussionmentioning

confidence: 99%

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Bukenya

Hout

Shayo

et al. 2022

PLOS Glob Public Health

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Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after integration. Healthcare workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations or purchase drugs prior to the establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual’s condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.

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Section: Discussionmentioning

confidence: 99%

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Bukenya

Hout

Shayo

et al. 2022

PLOS Glob Public Health

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“…OOP payment for healthcare can provide obstacles for treatment access particularly to the poorest, skewing treatment seeking towards only those that can afford to pay. 48 The higher proportion of unemployed caregivers presenting outpatient compared with inpatient may be an indicator of reduced access to hospitalised care by poorer households. The differences in household income levels between the hospitals show a preference for the secondary hospital by poorer households.…”

Section: Discussionmentioning

confidence: 99%

“…This may be the case because drugs and medical consumables are usually excluded from these subsidised care and when they are included, they are usually out-of-stock, meaning families have to get them from other providers and often at higher OOP costs. 48 CBHI is currently being implemented in many states across Nigeria including Kano state and primarily targets the formal sector with expanding cover to vulnerable groups (women and children), informal sector and rural areas. However, we show that admissions at the state facility (MMSH) where services are supposed to ‘free’ and U5s covered by the CBHI, increased the odds of CHE 25 almost fourfold.…”

Section: Discussionmentioning

confidence: 99%

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

et al. 2022

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BackgroundPneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income.MethodsWe recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary level hospital and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor).ResultsOf 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14–22) for outpatients and US$272 (US$271–360) for inpatients. Median household cost was US$51 (US$40–69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE, respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs and caregiver having a non-salaried job.ConclusionProvider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.

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“…OOP payment for healthcare can provide obstacles for treatment access particularly to the poorest, skewing treatment seeking towards only those than can afford to pay. [44] The higher proportion of unemployed caregivers presenting outpatient compared to inpatient may be an indicator of reduced access to hospitalised care by poorer households. The differences in household income levels between the hospitals shows a preference for the secondary hospital by poorer households.…”

Section: Discussionmentioning

confidence: 99%

“…This may be the case because drugs and medical consumables are usually excluded from these subsidised care and when they are included, they are usually out-of-stock, meaning families have to get them from other providers and often at higher OOP costs. [44] CBHI is currently being implemented in many states across Nigeria including Kano state and primarily targets the formal sector with expanding cover to vulnerable groups (women and children), informal sector and rural areas.…”

Section: Discussionmentioning

confidence: 99%

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

Adamu

Karia

Bello

et al. 2021

Preprint

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Background: Pneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the Pneumococcal Conjugate Vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income. Methods: We recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor). Results: Of 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14-22) for outpatients and US$272 (US$271-360) for inpatients. Median household cost was US$51 (US$40-69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs, and caregiver having a non-salaried job. Conclusion: Provider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.

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A qualitative inquiry of access to and quality of primary healthcare in seven communities in East and West Africa (SevenCEWA): perspectives of stakeholders, healthcare providers and users

Cited by 15 publications

References 34 publications

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

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