scholarly journals The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018

2019 ◽  
Vol 4 (6) ◽  
pp. e001809
Author(s):  
Paola Salari ◽  
Laura Di Giorgio ◽  
Stefania Ilinca ◽  
Jane Chuma
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Scale Up ◽  
Two Dimensions ◽  
Poor People ◽  
Financial Protection ◽  
Health Coverage ◽  
Catastrophic Payments ◽  
The Impact

IntroductionProgress towards effective service coverage and financial protection—the two dimensions of Universal Health Coverage (UHC)—has been limited in Kenya in the last decade. The government of Kenya has embarked on a highly ambitious reform programme currently being piloted in four Kenyan counties and aiming at national rollout by 2022. This study provides an updated assessment of the performance of the Kenyan health system in terms of financial protection allowing to monitor trends over time. In light of the UHC initiative, the study provides a baseline to assess the impact of the UHC pilot programme and inform scale-up plans. It also investigates household characteristics associated with catastrophic payments.MethodsUsing data from the Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2018, we investigated the incidence and intensity of catastrophic and impoverishing health expenditure. We used a logistic regression analysis to assess households’ characteristics associated with the probability of incurring catastrophic health expenditures.ResultsThe results show that the incidence of catastrophic payments is more severe for the poorest households and in the rural areas and mainly due to outpatient services. Results for the impoverishing effect suggest that after accounting for out-of-pocket(OOP) payments, the proportion of poor people increases by 2.2 percentage points in both rural and urban areas. Thus, between 1 and 1.1 million individuals are pushed into poverty due to OOP payments. Among the characteristics associated with the probability of incurring OOP expenditures, socioeconomic conditions, the presence of elderly and of people affected by chronic conditions showed significant results.ConclusionKenya is still lagging behind in terms of protecting its citizens against financial risks associated with ill health and healthcare seeking behaviour. More effort is needed to protect the most vulnerable population groups from the high costs of illness.

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2019 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Significant Proportion ◽  
Health Spending ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health ◽  
Out Of Pocket Payments

Abstract Background About 5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia and examine the factors associated with this impoverishment.Methods This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment.Results Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts.Conclusion In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

scholarly journals Enhancing food security through home gardening in urbanizing environment in Machakos County, Kenya

2021 ◽  
Vol 10 (3) ◽  
pp. 450-455
Author(s):  
Julius Huho ◽  
Margaret Muriuki
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Rural Areas ◽  
Urban Areas ◽  
Scale Up ◽  
Home Gardens ◽  
Capital City ◽  
Small Scale ◽  
Home Gardening ◽  
The Impact

Kenya is rapidly urbanizing at an annual rate of about 4.3%. One of the consequences of urbanization has been the problem of food insecurity in peri-urban areas. Increased migration to urban from rural areas has enhanced food insecurity in these areas. The peri-urban area of Kangundo-Tala in Machakos County is one of the fastest-growing peri-urban areas due to its proximity to the capital city of Nairobi. This study investigated the impact of home gardening in enhancing food security in the rapidly urbanizing middle-income Kangundo–Tala peri-urban areas of Machakos County, Kenya. The specific objectives of the study were: to identify the causes of households’ food insecurity in the study area; to examine the factors influencing the adoption of home gardening and; to establish the role of home gardening as a measure of households’ food security. To measure food security, three consumption behaviors were analyzed: consumption changes, food expenditure reduction and income expansion. A qualitative approach was adopted where a total of 120 newly settled households were interviewed. The three main causes of food insecurity were identified (i) small land sizes, (ii) low and erratic rainfall and, (iii) the socialization of peri-urban dwellers. About 68% of the households were practicing at least one form of home gardening. The need for safe and nutritious food, seasonal unavailability, and inaccessibility of food encouraged the establishment of home gardens. From the gardens, households were able to diversify their diets, access safe food and have food readily available. With enhanced stability in food availability, accessibility, and utilization, the study concluded that home gardens played a major role in enhancing food. However, the production was at a very small scale. Up-scaling of home gardening by the Ministry of Agriculture through training was recommended.    

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2020 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Addis Ababa ◽  
Significant Proportion ◽  
Health Spending ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health ◽  
Out Of Pocket Payments

Abstract Background: About5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia and examine the factors associated with this impoverishment. Methods: This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. Results: Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. At regional level, impoverishment ranged between 2.35% in Harari and 0.35% in Addis Ababa. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts. Conclusion:In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

scholarly journals Predictors of catastrophic out-of-pocket health expenditure in rural Egypt: application of the heteroskedastic probit model

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Suzan Abdel-Rahman ◽  
Farouk Shoaeb ◽  
Mohamed Naguib Abdel Fattah ◽  
Mohamed R. Abonazel
Keyword(s):  
Private Sector ◽  
Rural Areas ◽  
Health Expenditure ◽  
Health Spending ◽  
Probit Model ◽  
Chronically Ill ◽  
Catastrophic Health Expenditure ◽  
Health Coverage ◽  
Household Heads ◽  
The Impact

Abstract Background Out-of-pocket (OOP) health expenditure is a pressing issue in Egypt and far exceeds half of Egypt’s total health spending, threatening the economic viability, and long-term sustainability of Egyptian households. Targeting households at risk of catastrophic health payments based on their characteristics is an obvious pathway to mitigate the impoverishing impacts of OOP health payments on livelihoods. This study was conducted to identify the risk factors of incurring catastrophic health payments hoping to formulate appropriate policies to protect households against financial catastrophes. Methods Using data derived from the Egyptian Household Income, Expenditure, and Consumption Survey (HIECS), a multiplicative heteroskedastic probit model is applied to account for heteroskedasticity and avoid biased and inconsistent estimates. Results Accounting for heteroskedasticity induces notable differences in marginal effects and demonstrates that the impact of some core variables is underestimated and insignificant and in the opposite direction in the homoscedastic probit model. Moreover, our results demonstrate the principal factors besides health status and socioeconomic characteristics responsible for incurring catastrophic health expenditure, such as the use of health services provided by the private sector, which has a dramatic effect on encountering catastrophic health payments. Conclusions The marked differences between estimates of probit and heteroskedastic probit models emphasize the importance of investigating homoscedasticity assumption to avoid policies based on incorrect evidence. Many policies can be built upon our findings, such as enhancing the role of social health insurances in rural areas, expanding health coverage for poor households and chronically ill household heads, and providing adequate financial coverage for households with a high proportion of elderly, sick members, and females. Also, there is an urgent need to limit OOP health payments absorbed by private sector to achieve an acceptable level of fair financing.

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2019 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Formal Education ◽  
Significant Proportion ◽  
Health Spending ◽  
Poverty Line ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health

Abstract Background About 5% of the global population, predominantly in low-and-middle income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia, and examine the factors associated with this impoverishment. Methods This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various out-patient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. Results Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 877,000 individuals) into poverty. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to an urban residence. On the other hand, the households headed by males, and adults with a formal education decreased the likelihood of impoverishment, compared to their counterparts. Conclusion In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lack financial protection. More is required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

Impact of Elected Women Representatives of Panchayati Raj in Physical and Financial and Business Assets Development of Rural Women: A Study among the Rural Women’s of Tiruvannamalai District, Tamil Nadu[1]

2017 ◽  
Vol 4 (24) ◽  
Author(s):  
Kalaichelvi Sivaraman ◽  
Rengasamy Stalin
Keyword(s):  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Direct Democracy ◽  
Tamil Nadu ◽  
Local Level ◽  
Rural And Urban Areas ◽  
The Government ◽  
The Impact ◽  
Panchayati Raj

This research paper is the part of Research Project entitled “Impact of Elected Women Representatives in the Life and Livelihood of the Women in Rural Areas: With Special Reference to Tiruvannamalai District, Tamil Nadu” funded by University of Madras under UGC-UPE Scheme.The 73rd and 74th amendments of the Constitution of India were made by the government to strengthen the position of women and to create a local-level legal foundation for direct democracy for women in both rural and urban areas. The representation for women in local bodies through reservation policies amendment in Constitution of India has stimulated the political participation of women in rural areas. However, when it’s comes to the argument of whether the women reservation in Panchayati Raj helps or benefits to the life and livelihood development of women as a group? The answer is hypothetical because the studies related to the impact of women representatives of Panchayati Raj in the life and livelihood development of women was very less. Therefore, to fill the gap in existing literature, the present study was conducted among the rural women of Tiruvannamalai district to assess the impact of elected women representatives in the physical and financial and business development of the women in rural areas. The findings revealed that during the last five years because of the women representation in their village Panjayati Raj, the Physical Asset of the rural women were increased or developed moderately (55.8%) and Highly (23.4%) and the Financial and Business Asset of the rural women were increased or developed moderately (60.4%) and Highly (18.7%).

Komparácia pro-poor rastu vo vidieckych a mestských oblastiach Indonézie

2021 ◽  
Author(s):  
Barbora Frličková
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Poor People ◽  
Average Income ◽  
Poor Growth ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Poverty And Inequality ◽  
Partial Period ◽  
Urban And Rural Areas

The paper analyses construction and use of a selected indicator of pro-poor growth – the rate of pro-poor growth. It further explains the interpretation of this indicator in absolute and relative terms and indicates how economic growth affects poverty and inequality. The selected indicator is applied to the example of Indonesia and compares pro-poor growth in urban and rural areas of the country, examines regional disparities in terms of pro-poor growth for the period 1996–2019. From the absolute interpretation, pro-poor growth is observed in both urban and rural areas over the whole period. In relative terms, results of pro-poor growth for the first partial period (1996–2000) differ. While there was a relative pro-poor growth in the rural areas, there was a strong pro-poor growth in the cities with a significant decline in inequality observed (incomes of poor people increased while the average income of the whole population dropped). Indonesia achieved trickle-down growth in both rural and urban areas in two remaining periods (2000–2010 and 2010–2019).

IMPACT OF DIGITAL MARKETING: THE PRESENT SCENARIO IN TELANGANA STATE – AN EMPERICAL STUDY

2021 ◽  
Vol 8 (65) ◽  
pp. 15164-15172
Author(s):  
S. Pratap ◽  
Aziz Fatima
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Digital Marketing ◽  
Rural And Remote ◽  
Remote Areas ◽  
Wide Range ◽  
Rural And Remote Areas ◽  
Telangana State ◽  
The Impact ◽  
Made In

In present scenario of COVID-19, the effect of pandemic on Digital Marketing is visible not only in urban areas but also in rural areas. Customers are searching for various products and services through Google by which they can purchase wide range of products and services to fill their needs and desires at relatively low price. The freedom to select numerous products is available by browsing various websites. Hence this study focuses on Impact of digital marketing particularly in the selected rural areas of Telangana state. This state been formed recently but in the IT sector it is receiving much attention throughout the globe, as many MNC’s are establishing their operations in this state. Therefore, an attempt has been made in this study to find out how the Impact of digital marketing is trickling down in the rural and remote areas of newly formed Telangana state. Hence this study focuses the impact of digital marketing in the selected areas of Telangana state.

Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

2021 ◽  
pp. 1-7
Author(s):  
Carlos Mena Canata ◽  
Rebeca Noemí Ruiz Vallejos
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rural Areas ◽  
Urban Areas ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

scholarly journals Modeling Charging Infrastructure Requirements to Achieve a Holistic E-Mobility Integration in Regional Energy Systems

2021 ◽  
Author(s):  
Dominik Husarek ◽  
Simon Paulus ◽  
Michael Metzger ◽  
Vjekoslav Salapic ◽  
Stefan Niessen
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Mobility Model ◽  
Residential Areas ◽  
Charging Infrastructure ◽  
Charging System ◽  
Charging Station ◽  
Grid Operators ◽  
Regional Energy Systems ◽  
The Impact

Since E-Mobility is on the rise worldwide, large Charging Infrastructure (CI) networks are required to satisfy the upcoming Charging Demand (CD). Understanding this CD with its spatial and temporal uncertainties is important for grid operators to quantify the grid impact of Electric Vehicle integration and for Charging Station (CS) operators to assess long-term CI investments. Hence, we introduce an Agent-based E-Mobility Model assessing regional CI systems with their multi-directional interactions between CSs and vehicles. A Global Sensitivity Analysis (GSA) is applied to quantify the impact of 11 technical levers on 17 relevant charging system outputs. The GSA evaluates the E-Mobility integration in terms of grid impact, economic viability of CSs and Service Quality of the deployed Charging Infrastructure (SQCI). Based on this impact assessment we derive general guidelines for E-Mobility integration into regional systems. We found, inter alia, that CI policies should aim at allocating CSs across different types of locations to utilize cross-locational effects such as CSs at public locations affecting the charging peak in residential areas by up to 18%. Additionally, while improving the highway charging network is an effective lever to increase the SQCI in urban areas, public charging is an even stronger lever in rural areas.

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