The economic burden of chronic non-communicable diseases in rural Malawi: an observational study

Abstract

BackgroundEvidence from population-based studies on the economic burden imposed by chronic non-communicable diseases (CNCDs) is still sparse in Sub-Saharan Africa. Our study aimed to fill this existing gap in knowledge by estimating both the household direct, indirect, and total costs incurred due to CNCDs and the economic burden households bear as a result of these costs in Malawi.MethodsThe study used data from the first round of a longitudinal household health survey conducted in 2012 in three rural districts in Malawi. A cost-of-illness method was applied to estimate the economic burden of CNCDs. Indicators of catastrophic spending and impoverishment were used to estimate the economic burden imposed by CNCDs on households.ResultsA total 475 out of 5643 interviewed individuals reported suffering from CNCDs. Mean total costs of all reported CNCDs were 1,040.82 MWK, of which 56.8 % was contributed by direct costs. Individuals affected by chronic cardiovascular conditions and chronic neuropsychiatric conditions bore the highest levels of direct, indirect, and total costs. Using a threshold of 10 % of household non-food expenditure, 21.3 % of all households with at least one household member reporting a CNCD and seeking care for such a condition incurred catastrophic spending due to CNCDs. The poorest households were more likely to incur catastrophic spending due to CNCDs. An additional 1.7 % of households reporting a CNCD fell under the international poverty line once considering direct costs due to CNCDs.ConclusionOur study showed that the economic burden of CNCDs is high, causes catastrophic spending, and aggravates poverty in rural Malawi, a country where in principle basic care for CNCDs should be offered free of charge at point of use through the provision of an Essential Health Package (EHP). Our findings further indicated that particularly high direct, indirect, and total costs were linked to specific diagnoses, although costs were high even for conditions targeted by the EHP. Our findings point at clear gaps in coverage in the current Malawian health system and call for further investments to ensure adequate affordable care for people suffering from CNCDs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1716-8) contains supplementary material, which is available to authorized users.

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“…This finding was comparable to a study done in Kenya 20 though higher than a report from Malawi (21.3%). 30 The variation in the study findings might be partly related to difference in settings and the scope of cost estimation. The earlier study was done only on hypertension illness and the later study considered other non-communicable illnesses in addition to hypertension.…”

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“…A study in Uganda that used both the national ($1.31) and the international ($1.25) poverty line [ 57 ] finds that the percentage poverty head count after health payment is higher when IPL is applied at 18.1%, while that of the NPL was 17.1%. Only one study in Malawi assesses impoverishment due to CHE for chronic illness [ 58 ]; all the other assessed impoverished due to CHE related to general health care.…”

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“…There also exists evidence that outpatient care expenses have the highest proportion in healthcare costs [28] and this can be attributed to the fact that social health insurance schemes in developing countries like India do not cover outpatient care [33]. There also exists enough empirical literature that suggests a positive relation between chronic illness and OOP health expenditure in LMICs [10,[34][35][36][37][38]. This is primarily because chronic care for NCDs is costly and place substantial burden on household budgets by increasing OOP payments and impoverishing households [39][40][41].…”