Effect of COVID-19 on the risk of household demand for health care in Togo

Background Barriers on the demand side of the health care system are as important as supply side factors in deterring patients from obtaining effective treatment during COVID-19. Developing countries, including Togo, have focused on reducing the risk of health care use during this period by ensuring basic health care services, as an important policy to improve health outcomes and meet international obligations to make health services accessible. Methods The data used come from a national household survey conducted from 8 to 17 July 2020 covering all 44 districts of Togo's 6 health regions. In each district capital, a minimum of 30 households were included by a systematic random draw at two levels (district then household). On the basis of these data, the multinomial regression model is used to identify the risk factors for the demand for health care services during COVID-19. Results A total of 1946 (with a response rate of 98.3%) participants were included in the study. The conclusion on households over 60 years of age indicates that the relative risk ratio (RRR = 23.97; 95% CI = 0.93; 615.38) allows households to practice self-medication instead of modern care structures. The multinomial model revealed that the relative risk ratio of activities before COVID-19 (RRR = 4.879; 95% CI = 1.018; 23.38) allows households to maintain their choice of self-medication and (RRR = 3.139; 95% CI = 0.91; 0.829) to prefer public health centre. As an educated head of household (RRR = 0.192; 95% CI = 0.017, 2.113) he prefers the choice of private health centre during COVID-19. Conclusions This study found that the majority (30.49%) of patients sought health care. The analysis shows that the loss of employment, pre-COVID-19 activities in households and regions not infected by the pandemic allow households to remain in the choice of health care demand (self-medication and public hospitals) despite the impacts of COVID-19. On the other hand, the level of higher education and age determine an alternative choice of health care provision by households. Therefore, policy makers need to put a particular emphasis on social policies to address household health shocks.