Background:
Noncommunicable diseases (NCDs) are a major and growing cause of death and disability in low-income countries, and contribute a substantial portion of outpatient clinic visits. Poverty can be a major barrier to accessing healthcare in rural low-income countries. The objective of this study is to describe the demographics and socioeconomic status of patients attending an NCD clinic in rural Haiti, where poverty is highly prevalent.
Methods:
We analyzed routinely collected clinic data from adult patients in rural Haiti presenting to the NCD clinic at Hôpital Universitaire de Mirebalais. We collected data during routine initial clinic visits from July 2013 through October 2016. We performed descriptive statistics to assess patient demographics and socioeconomic status using available data. We evaluated poverty based on the Multidimensional Poverty Index by evaluating 9 indicators within three dimensions: health, education, and standard of living - we did not assess electricity. We assessed deprivation within each indicator. The “poorest” patients were defined as those deprived in 4 of the 9 poverty indicators. We also assessed measures of catastrophic health spending.
Results:
A total of 518 adults were included, with 72% (373/508) women. The mean overall age was 52.8 years (SD 14.7) and 21% (108/518) were 40 years old or younger. Of the patients, 32% had only hypertension, 18% had only diabetes, 32% had both diabetes and hypertension, 5% had heart failure, and 13% had no recorded diagnosis. 45% of patients travel more than 1 hour for clinic visits. Almost half (49%, 146/296) of adults sold belongings and 61% (178/292) borrowed money to pay for healthcare. Among the poverty measures, the top indicators with deprivation were cooking fuel with charcoal or wood (96%, 290/302), child death in household (70%, 169/243), and no household members completing primary school (25%, 83/324), lack of household assets (25%, 79/313), poor sanitation (19%, 59/304), dirt floor (16%, 50/304), and lack of improved drinking water (9%, 29/308). Of all patients, 21% (78/378) were among the poorest. Throughout Haiti, however, 55% of the population are among the poorest. There were more patients among the poorest living closer to the hospital (27%) than living farther away (10%).
Interpretation:
The great majority of patients were middle-aged women, with predominantly hypertension and/or diabetes. Socioeconomic deprivation was high among many poverty indicators and most patients experienced catastrophic health spending. At this clinic in rural Haiti, the proportion of patients presenting for care who are among the poorest is less than that overall in Haiti. Patients who travel far distances have less poverty. Health systems for chronic disease management in rural low-income countries must account for patient poverty.
Satisfaction with health care system: A comparative study between market-based insurance model of the United States and “out-of-pocket” model in developing and low-income countries
