Out-of-pocket expenditure in a country with universal health coverage: A qualitative study on patients with liver cirrhosis in Sri Lanka

Abstract Background The popular use of traditional medicine in low-income settings has previously been attributed to poverty, lack of education, and insufficient accessibility to conventional health service. However, in many countries, including in Rwanda, the use of traditional medicine is still popular despite the good accessibility and availability of conventional health services. This study aims to explore why traditional medicine is popularly used in Rwanda where it has achieved universal health coverage. Methods The qualitative study, which included in-depth interviews and participant observations, investigated the experience of using traditional medicine as well as the perceived needs and reasons for its use in the Musanze district of northern Rwanda. We recruited 21 participants (15 community members and 6 traditional healers) for in-depth interviews. Thematic analysis was conducted to generate common themes and coding schemes. Results Our findings suggest that the characteristics of traditional medicine are responding to community members’ health, social and financial needs which are insufficiently met by the current conventional health services. Participants used traditional medicine particularly to deal with culture-specific illness – uburozi. To treat uburozi appropriately, referrals from hospitals to traditional healers took place spontaneously. Conclusions In Rwanda, conventional health services universally cover diseases that are diagnosed by the standard of conventional medicine. However, this universal health coverage may not sufficiently respond patients’ social and financial needs arising from the health needs. Given this, integrating traditional medicine into national health systems, with adequate regulatory framework for quality control, would be beneficial to meet patients’ needs.

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Public–private partnerships for universal health coverage? The future of “free health” in Sri Lanka

Globalization and Health ◽

10.1186/s12992-019-0522-6 ◽

2019 ◽

Vol 15 (S1) ◽

Author(s):

Ramya Kumar

Keyword(s):

Sri Lanka ◽

Healthcare System ◽

Universal Health Coverage ◽

Historical Context ◽

Health Indicators ◽

Public Private Partnerships ◽

Health Coverage ◽

Private Interests ◽

Free Healthcare ◽

Universal Health

AbstractSri Lanka reports impressive health indicators compared to its peers in the South Asian region. Maternal and infant mortality are relatively low, and several intractable communicable diseases have been eliminated. The publicly financed and delivered “free” healthcare system has been critical to these health achievements. Placing the country’s healthcare system in historical context, this commentary analyses the contradictions and political tensions surrounding Sri Lanka’s 2018 Universal Health Coverage (UHC) policy, with attention to the Ministry of Health’s plans for public–private partnerships (PPP). As economic exigencies and private interests increasingly erode the 1951 “Free Health” policy, this commentary calls for a re-envisioning of UHC that can meet people’s aspirations for health and social justice.

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Are We Contented in Achieving Universal Health Coverage in Treating Dengue Patients in Sri Lanka?

10.21203/rs.3.rs-37783/v1 ◽

2020 ◽

Author(s):

Nadeeka Perera ◽

Amala De Silva ◽

Dulshika Amarasinghe Wass ◽

Ananda Wijewickrama ◽

Shamini Prathapan

Keyword(s):

Sri Lanka ◽

Universal Health Coverage ◽

Dengue Infection ◽

Systematic Sampling ◽

Health Coverage ◽

Monthly Income ◽

Hospitalization Costs ◽

Household Costs ◽

Universal Health ◽

Household Cost

Abstract BackgroundAmong infectious diseases, Dengue illness causes a major public health threat in Sri Lanka. The preventive and the curative services place a financial burden on the state health sectorand household cost and out of pocket expenditure also are important cost components embedded with Dengue infection. ObjectiveTo estimate the household costs andout of pocket expenditure incurred due to Dengue infection among adults who received institutional care.MethodsA longitudinal study was conducted from July to December 2018. Fifty patients each from DF and DHF categories were recruited with systematic sampling admitted to an institution in Colombo District, Sri Lanka.Adults residing in Colombo District of Sri Lanka for more than six months prior to Dengue/DHF episode, were recruited based on a systematic sampling method. Details were obtained via an interviewer administered questionnaire. They were interviewed on day of discharge from the hospital and were followed up for two weeks. Unit cost per patient was calculated. The household costs were calculated for three phases; ambulatory cost, costs incurred during hospitalization and post hospitalization costs. These components were described using mean, median, standard deviation and inter-quartile range and out of pocket expenditure were calculatedResultsThe median age in DF group was 38.5 years and in DHF group was 28.5 years.Average household cost was US$127.69(SD=93.32) and US$134.71(SD=94.31) for DF and DHF patients respectively. Among DF patients 98.03% was borne using OOPE and among DHF patients it was 95.57%. In 2016, the average monthly income of a household in Colombo was US$571.82. Thereforenearly 25% of the monthly income had been spent on a single adult with Dengue.Conclusions and RecommendationsIf an adult member is hospitalized with Dengueinfection the Out of pocket expenditure is high, which is nearly 25% of a family’s monthly income.Strengthening the Dengue control programme is the key towards Universal Health Coverage.

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Are we Contented in Achieving Universal Health Coverage in Treating Dengue Patients in Sri Lanka?

10.21203/rs.3.rs-122506/v1 ◽

2020 ◽

Author(s):

Nadeeka Perera ◽

Amala De Silva ◽

Dulshika Amarasinghe Wass ◽

Ananda Wijewickrama ◽

Shamini Prathapan

Keyword(s):

Sri Lanka ◽

Universal Health Coverage ◽

Dengue Infection ◽

Systematic Sampling ◽

Health Coverage ◽

Monthly Income ◽

Hospitalization Costs ◽

Household Costs ◽

Universal Health ◽

Household Cost

Abstract BackgroundAmong infectious diseases, Dengue illness causes a major public health threat in Sri Lanka. The preventive and the curative services place a financial burden on the state health sector and household cost and out of pocket expenditure also are important cost components embedded with Dengue infection. ObjectiveTo estimate the household costs and out of pocket expenditure incurred due to Dengue infection among adults who received institutional care.MethodsA longitudinal study was conducted from July to December 2018. Fifty patients each from DF and DHF categories were recruited with systematic sampling admitted to an institution in Colombo District, Sri Lanka. Adults residing in Colombo District of Sri Lanka for more than six months prior to Dengue/DHF episode, were recruited based on a systematic sampling method. Details were obtained via an interviewer administered questionnaire. They were interviewed on day of discharge from the hospital and were followed up for two weeks. Unit cost per patient was calculated. The household costs were calculated for three phases; ambulatory cost, costs incurred during hospitalization and post hospitalization costs. These components were described using mean, median, standard deviation and inter-quartile range and out of pocket expenditure were calculatedResultsThe median age in DF group was 38.5 years and in DHF group was 28.5 years. Average household cost was US$127.69(SD=93.32) and US$134.71(SD=94.31) for DF and DHF patients respectively. Among DF patients 98.03% was borne using OOPE and among DHF patients it was 95.57%. In 2016, the average monthly income of a household in Colombo was US$571.82. Therefore nearly 25% of the monthly income had been spent on a single adult with Dengue.ConclusionsIf an adult member is hospitalized with Dengue infection the Out of pocket expenditure is high, which is nearly 25% of a family’s monthly income. Strengthening the Dengue control programme is the key towards Universal Health Coverage.

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Education, leadership and partnerships: nursing potential for Universal Health Coverage

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1092.2673 ◽

2016 ◽

Vol 24 (0) ◽

Cited By ~ 4

Author(s):

Isabel Amélia Costa Mendes ◽

Carla Aparecida Arena Ventura ◽

Maria Auxiliadora Trevizan ◽

Leila Maria Marchi-Alves ◽

Valtuir Duarte de Souza-Junior

Keyword(s):

Qualitative Study ◽

Universal Health Coverage ◽

Education Leadership ◽

Document Analysis ◽

World Health ◽

Health Coverage ◽

Partnership Development ◽

The World ◽

Health Organization ◽

Universal Health

Objective: to discuss possibilities of nursing contribution for universal health coverage. Method: a qualitative study, performed by means of document analysis of the World Health Organization publications highlighting Nursing and Midwifery within universal health coverage. Results: documents published by nursing and midwifery leaders point to the need for coordinated and integrated actions in education, leadership and partnership development. Final Considerations: this article represents a call for nurses, in order to foster reflection and understanding of the relevance of their work on the consolidation of the principles of universal health coverage.

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Regulating the for-profit private healthcare providers towards universal health coverage: A qualitative study of legal and organizational framework in Mongolia

The International Journal of Health Planning and Management ◽

10.1002/hpm.2417 ◽

2017 ◽

Vol 33 (1) ◽

pp. 185-201 ◽

Cited By ~ 4

Author(s):

Uranchimeg Tsevelvaanchig ◽

Indermohan S. Narula ◽

Hebe Gouda ◽

Peter S. Hill

Keyword(s):

Qualitative Study ◽

Universal Health Coverage ◽

Healthcare Providers ◽

Health Coverage ◽

For Profit ◽

Private Healthcare ◽

Organizational Framework ◽

Universal Health

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Challenges to achieving universal health coverage through community-based health planning and services delivery approach: a qualitative study in Ghana

BMJ Open ◽

10.1136/bmjopen-2018-024845 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024845 ◽

Cited By ~ 6

Author(s):

Abraham Assan ◽

Amirhossein Takian ◽

Moses Aikins ◽

Ali Akbarisari

Keyword(s):

Qualitative Study ◽

Universal Health Coverage ◽

Low Income ◽

Health Planning ◽

National Level ◽

Health Coverage ◽

Community Based ◽

Services Delivery ◽

Universal Health ◽

Local Levels

ObjectiveCommunity-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and middle-income countries. This study is first of its kind (following the launch of the Sustainable Developments Goal [SDG]) and aimed to holistically explore the challenges to achieving UHC through the community-based health planning and service (CHPS) initiative in Ghana.DesignA qualitative study design was adopted to explore the phenomenon. Face-to-face indepth interviews were conducted from April 2017 until February 2018 through purposive and snowball sampling techniques. Data were analysed using inductive and deductive thematic analysis approach.SettingData were gathered at the national level, in addition to the regional, district and subdistrict/local levels of four regions of Ghana. Sampled regions were Central Region, Greater Accra Region, Upper East Region and Volta Region.ParticipantsIn total, 67 participants were interviewed: national level (5), regional levels (11), district levels (9) and local levels (42). Interviewees were mainly stakeholders—people whose actions or inactions actively or passively influence the decision-making, management and implementation of CHPS, including policy makers, managers of CHPS compound and health centres, politicians, academics, health professionals, technocrats, and community health management committee members.ResultsBased on our findings, inadequate understanding of CHPS concept, major contextual changes with stalled policy change to meet growing health demands, and changes in political landscape and leadership with changed priorities threaten CHPS sustainability.ConclusionUHC is a political choice which can only be achieved through sustainable and coherent efforts. Along countries’ pathways to reach UHC, coordinated involvement of all stakeholders, from community members to international partners, is essential. To achieve UHC within the time frame of SDGs, Ghana has no choice but to improve its national health governance to strengthen the capacity of existing CHPS.

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