Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review

Infant mortality is a major health problem in developing countries. It is an important indicator of a country's public health as it goes hand in hand with socio-economic conditions and many others. Public health spending has been committed to reducing this scourge. This has led to the completion of numerous studies which have yielded mixed results. The main objective of this study is to test the effect of public health expenditure (% GDP) on the infant mortality rate, taking into account the role that institutional quality can play. To achieve this, we use two approaches which are the autoregressive vector panel model with exogenous variables (PVAR (X)) and the smooth threshold regression model (PSTR) on annual data covering the period 2002-2016 and covering 37 African countries. Sub-Saharan. Our main results through the PVAR (X) reveal that in the absence of institutional variables, public health expenditure has a negative and significant effect on the infant mortality rate, whereas, in the presence of the various institutional variables, this effect is still negative but is no longer significant. Our results show that the presence of institutions halves the weight of public health expenditure in explaining the infant mortality rate. In addition, our results show through the PSTR that there is a certain level of institutional qualities that these countries must achieve for public health expenditure to positively affect infant mortality rates. These thresholds oscillate for all the institutional variables around 7%. Taking institutional variables into account will help reduce infant mortality in Sub-Saharan African countries.

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Relationship between Public Debt Burden and Health Expenditure in Sub-Saharan African Countries: The Role of Institutional Quality

Journal of Business and Social Review in Emerging Economies ◽

10.26710/jbsee.v6i2.1092 ◽

2020 ◽

Vol 6 (2) ◽

Author(s):

Rusmawati Said ◽

Abdullahi Sani Morai

Keyword(s):

Public Debt ◽

Health Expenditure ◽

Institutional Quality ◽

Sub Saharan Africa ◽

African Countries ◽

The Public ◽

Debt Burden ◽

Sub Saharan ◽

The Relationship

The historically lower level of public health expenditure of sub-Saharan African (SSA) countries could be partly explained by the mounting debt burden of this region. This consumes a sizable proportion of their domestic resources to debt servicing and potentially decreases their overall budgetary allocations to various sectors in the economy and health expenditure in particular. Using the Generalized Method of Moments (GMM) approach on a sample of 43 sub-Saharan African countries, we examined the relationship between the public debt burden and health expenditure highlighting the role of institutional quality for the period 2000 – 2014. The empirical result confirms that the relationship between public debt burden and health expenditure in sub-Saharan Africa is negative. Interestingly, however, the marginal effect of the relationship between the public debt burden and health expenditure has shown that such a negative relationship turns out to be positive when the quality of the institutions is at maximum. This suggests that the relationship between the public debt burden and health expenditure in sub-Saharan Africa is a function of institutional quality. Therefore, to minimize the negative impact of public debt on health expenditure in sub-Saharan Africa, governments should take determine stand to minimize its debt accumulation and intensify efforts toward the improvement of institutional quality in the region comprehensively.

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Knowledge, attitude, perception, and preventative practices towards COVID-19 in sub-Saharan Africa: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0249853 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249853

Author(s):

Ugochinyere Ijeoma Nwagbara ◽

Emmanuella Chinonso Osual ◽

Rumbidzai Chireshe ◽

Obasanjo Afolabi Bolarinwa ◽

Balsam Qubais Saeed ◽

...

Keyword(s):

Scoping Review ◽

Positive Attitude ◽

Grey Literature ◽

Further Education ◽

Sub Saharan Africa ◽

World Health ◽

African Countries ◽

Preventive Practices ◽

Adequate Knowledge ◽

Sub Saharan

Background Knowledge, attitudes, perception, and preventative practices regarding coronavirus- 2019 (COVID-19) are crucial in its prevention and control. Several studies have noted that the majority of people in sub-Saharan African are noncompliant with proposed health and safety measures recommended by the World Health Organization (WHO) and respective country health departments. In most sub-Saharan African countries, noncompliance is attributable to ignorance and misinformation, thereby raising questions about people’s knowledge, attitudes, perception, and practices towards COVID-19 in these settings. This situation is particularly of concern for governments and public health experts. Thus, this scoping review is aimed at mapping evidence on the knowledge, attitudes, perceptions, and preventive practices (KAP) towards COVID-19 in sub-Saharan Africa (SSA). Methods Systematic searches of relevant articles were performed using databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, the WHO library and grey literature. Arksey and O’Malley’s framework guided the study. The risk of bias for included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVIVO version 10 was used to analyse the data and a thematic content analysis was used to present the review’s narrative account. Results A total of 3037 eligible studies were identified after the database search. Only 28 studies met the inclusion criteria after full article screening and were included for data extraction. Studies included populations from the following SSA countries: Ethiopia, Nigeria, Cameroon, Uganda, Rwanda, Ghana, Democratic Republic of Congo, Sudan, and Sierra Leone. All the included studies showed evidence of knowledge related to COVID-19. Eleven studies showed that participants had a positive attitude towards COVID-19, and fifteen studies showed that participants had good practices towards COVID-19. Conclusions Most of the participants had adequate knowledge related to COVID-19. Despite adequate knowledge, the attitude was not always positive, thereby necessitating further education to convey the importance of forming a positive attitude and continuous preventive practice towards reducing contraction and transmission of COVID‐19.

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Women in Parliament and Public Health Expenditure: Evidence from Sub-Saharan African Countries

Journal of Social Economics Research ◽

10.18488/journal.35.2021.82.66.76 ◽

2021 ◽

Vol 8 (2) ◽

pp. 66-76

Author(s):

Gael Fokam ◽

Paloma Mbengono ◽

Guilain Sato ◽

Willy Noumessi ◽

Dessy-Karl Tadadjeu

Keyword(s):

Public Health ◽

Health Expenditure ◽

African Countries ◽

Public Health Expenditure ◽

Women In Parliament ◽

Sub Saharan

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Nodding Syndrome: A Scoping Review

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6040211 ◽

2021 ◽

Vol 6 (4) ◽

pp. 211

Author(s):

Gasim Omer Elkhalifa Abd-Elfarag ◽

Arthur Wouter Dante Edridge ◽

René Spijker ◽

Mohamed Boy Sebit ◽

Michaël B. van Hensbroek

Keyword(s):

Scoping Review ◽

Treatment Options ◽

Original Data ◽

Current Evidence ◽

Future Research ◽

African Countries ◽

Comprehensive Overview ◽

Severe Condition ◽

Nodding Syndrome ◽

Sub Saharan

Nodding syndrome (NS) is a debilitating yet often neglected neurological disease affecting thousands of children in several sub-Saharan African countries. The cause of NS remains unknown, and effective treatment options are lacking. Moreover, knowledge regarding NS is scarce and is based on a limited number of publications, with no comprehensive overview published to date. Therefore, the aim of this scoping review was to summarise the current evidence and identify existing knowledge gaps in order to help clinicians, scientists, and policymakers develop guidelines for prioritising this severe condition. We searched the Medline (Ovid), Embase (Ovid), Scopus, and Global Health Library databases in accordance with the PRISMA extension for scoping review guidance and in accordance with the Joanna Briggs Institute guidelines and methodology for a scoping review, using keywords describing NS. We then extracted and presented the original data regarding the epidemiology, aetiology, pathophysiology, clinical features, diagnosis, management, and outcomes of NS, as well as community perceptions and the psychosocial and economic impact of NS. Out of 1470 identified articles, a total of 69 were included in this scoping review. Major gaps exist in understanding the aetiology and pathogenesis of NS. Future research is urgently needed not only to address these gaps, but also to study the treatment options, epidemiology, and psychosocial and economic impacts of NS. Innovative interventions and rehabilitation programmes designed to address the psychosocial and economic burdens associated with NS are also urgently needed.

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Community-orientated primary care: a scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa

BMJ Global Health ◽

10.1136/bmjgh-2019-001489 ◽

2019 ◽

Vol 4 (Suppl 8) ◽

pp. e001489 ◽

Cited By ~ 7

Author(s):

Bob Mash ◽

Sunanda Ray ◽

Akye Essuman ◽

Edu Burgueño

Keyword(s):

South Africa ◽

Primary Care ◽

Scoping Review ◽

Health Workers ◽

Historical Analysis ◽

Sub Saharan Africa ◽

African Countries ◽

Scoping Reviews ◽

Study Characteristics ◽

Sub Saharan

IntroductionCommunity-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility.MethodsDatabases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness.ResultsA total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC.ConclusionsThere is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.

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Barriers and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: a scoping review

BMC Health Services Research ◽

10.1186/s12913-019-4822-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Molalign B. Adugna ◽

Fatima Nabbouh ◽

Selvia Shehata ◽

Setareh Ghahari

Keyword(s):

Health Services ◽

Scoping Review ◽

Search Strategy ◽

Healthcare Professionals ◽

Healthcare Access ◽

Healthcare Services ◽

African Countries ◽

Middle Income ◽

Low Education ◽

Sub Saharan

Abstract Background Children with disabilities (CwDs) make up around 150 million of the billion people with disabilities in the world. The Sub-Saharan African countries have a large number of CwDs who have limited access to healthcare and rehabilitation care. This, combined with chronic poverty, low education, and inadequately trained healthcare professionals, substantially lowers these children’s quality of life. The main objective of this scoping review was to discover the barriers and facilitators to healthcare access for CwDs in selected low to middle income Sub-Saharan African countries. As African countries significantly vary in socioeconomic status, we only focused on countries in Sub-Saharan Africa who allocated less than $50/person to healthcare. Methods A broad and iterative search strategy using multiple sources and databases including CINAHL, Medline, Global Health, and Embase were utilized. Using a comprehensive search strategy, 704 articles were generated. After removal of the duplicates, 466 of them were screened based on the study inclusion and exclusion criteria. After iterative reading and screening of these articles, a final 15 articles were included in this review. Results This scoping review shows that CwDs in the selected Sub-Saharan African countries face major barriers including stigma and negative attitudes, poverty and insufficient resources, inadequate policy implementations, physical inaccessibility, lack of transportation, lack of privacy, and inadequately trained healthcare professionals to deal with disability. Emotional and social support, including peer support for CwDs and caregivers, were identified as facilitators for better access to health services. Conclusions There is limited access to healthcare services in the low and middle income Sub-Saharan African countries due to poverty, low education, inadequate healthcare systems, and shortage of healthcare professionals. It is evident that there are socioeconomic, cultural, and physical related impediments that affect CwDs’ and their caregivers’ access to the required healthcare services. Policy development, improved physical accessibility, public disability awareness, and parental support are some of the key facilitators to access healthcare services. The study highlights the importance of revisions to childhood disability and healthcare provisions policy and practice as well as sustainable rehabilitation programs. Further research is required to explore ways to improve experience of accessing health services.

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The Effect of Healthcare Expenditure on the Health Outcomes in Sub-Saharan African Countries

Asian Journal of Economics Business and Accounting ◽

10.9734/ajeba/2019/v12i430158 ◽

2019 ◽

pp. 1-22

Author(s):

Xing Weibo ◽

Birhanu Yimer

Keyword(s):

Health Outcome ◽

Infant Mortality ◽

Life Expectancy ◽

Health Outcomes ◽

Health Expenditure ◽

Sub Saharan Africa ◽

African Countries ◽

Under Five ◽

Per Capita ◽

Sub Saharan

Health is a major component for a fulfilled life that everyone in the world desires to acquire. Governments are expected to play a vital role in providing quality health service to their people. Even though an increased health care expenditure is mostly considered as a primary contributor for an improved health outcome, empirical studies however indicate controversial results. The primary objective of this paper is to examine the effect of health expenditure on the selected health outcomes (Life Expectancy, Infant Mortality, Under-Five Mortality and Crude death) in Sub Saharan Africa. The linear dynamic generalized method of moments instrumental variable (GMM-IV) was used on a panel of 39 Sub-Saharan African Countries for the years 1995-2014. Results of this study showed that health expenditure significantly improves life expectancy and lowers infant mortality, under-five mortality & crude death in Sub Saharan Africa. The separate effects of Public and private health expenditures have also shown a significant positive relationship on life expectancy and negative on infant mortality, under-five mortality & crude death. The one period lag of health expenditure was estimated and the regression results indicated statistically significant relationship with health outcomes. In addition to health expenditure, other determinants like Gross Domestic Product (GDP) per capita, urbanization, immunization and basic drinking water brought improvement on life expectancy, infant mortality, under-five mortality & crude death. In contrast, HIV prevalence and unemployment are factors that reduce life expectancy and increase infant mortality, under-five mortality & crude death. This study indicated that health expenditure is an important element in attaining improved health outcome in Sub-Saharan African Countries. Therefore, increasing the amount of health expenditure allocated to the health sector yields a better health status. More on, revising policies to improve GDP per capita, immunization, urbanization and basic drinking water service, and strategies intended to reduce HIV prevalence and unemployment assure a better health outcome.

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Healthcare Expenditure and Economic Growth in Sub-Saharan Africa

Asian Journal of Economics Business and Accounting ◽

10.9734/ajeba/2019/v13i230170 ◽

2020 ◽

pp. 1-7

Author(s):

Birhanu Yimer Ali ◽

Robert Moracha Ogeto

Keyword(s):

Economic Growth ◽

Foreign Direct Investment ◽

Direct Investment ◽

Health Expenditure ◽

Generalized Method Of Moments ◽

Health Sector ◽

Sub Saharan Africa ◽

Domestic Saving ◽

African Countries ◽

Sub Saharan

This paper investigated the effect of health expenditure on economic growth in Sub Saharan Africa. The linear dynamic generalized method of moments instrumental variable (GMM-IV) was used on a panel data of 38 Sub-Saharan African countries over the period 2000-2016. Findings reveal that health expenditure significantly improves economic growth in Sub Saharan Africa. The separate effects of Public and private health expenditures have also shown a significant positive relationship on economic growth. In addition to health expenditure, other determinants like gross domestic saving, foreign direct investment, and labor force brought a statistically significant improvement on economic growth, whereas official development assistance has a statistically insignificant effect on economic growth. This study concluded that health expenditure is an important element in attaining improved economic growth in Sub-Saharan African Countries as it assured a healthy workforce and the country’s populace. Therefore, increasing the amount of health expenditure allocated to the health sector yields a better economy. More on, revising policies to improve gross domestic savings and foreign direct investment also assure a better economic growth.

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Protocol for a scoping review to evaluate the extent of utilisation of healthcare services by asthma patients in sub-Saharan African countries

BMJ Open ◽

10.1136/bmjopen-2020-046294 ◽

2021 ◽

Vol 11 (8) ◽

pp. e046294

Author(s):

Pisirai Ndarukwa ◽

Moses John Chimbari ◽

Elopy Sibanda

Keyword(s):

Scoping Review ◽

Grey Literature ◽

Healthcare Services ◽

African Countries ◽

Similar Work ◽

Asthma Patients ◽

Registration Number ◽

Sub Saharan ◽

Ssa Countries

IntroductionHealth systems in sub-Saharan African (SSA) countries are fragile and centralised. Consequently, majority of people have restricted access to healthcare services. Given the rise in the prevalence and burden of asthma in SSA, it is imperative to scrutinise the utilisation of healthcare services by people with asthma. We aim to understand, through this review, the extent of utilisation of healthcare services by asthma patients in SSA countries.Methods and analysisArksey and O’Malley’s scoping review methodology framework will be used to guide the conduct of this scoping review. We will conduct a search of the literature on the electronic databases: Medline, (using PubMed interface), EMBASE, EBSCOHOST, Web of Science and Google Scholar, grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Registration of the proposed scoping review on the PROSPERO has indicated that no similar work has been or is being done elsewhere. We will review studies published on the subject from January 2009 to May 2020 in SSA.Ethics and disseminationThe proposed scoping review will contribute towards the knowledge base on utilisation of healthcare services particularly for people with asthma. This will provide a better understanding of the extent of utilisation of healthcare services by asthma patients and ultimately contribute to improvement of quality of care for people suffering from asthma. The results from the review will enlighten and guide healthcare practitioners and researchers on developing appropriate and feasible interventions to increase the utilisation of healthcare services by asthma patients in resource-constrained settings in SSA countries. Results of this scoping review will be disseminated through a peer-reviewed publication, conference presentations and a 1-day stakeholder meeting.PROSPERO registration numberCRD42020154127.

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