What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure

Research output: Contribution to journalArticlepeer-review

Authors

  • Manraj Phull
  • Caris E Grimes
  • Thaim B Kamara
  • Haja Wurie
  • Andrew J M Leather

Colleges, School and Institutes

Abstract

Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone. 
Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical, and indirect costs for surgical care, and summary household assets. Missing data were imputed.
Setting: The main tertiary level hospital in Freetown, Sierra Leone. Participants: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards.
Outcome measures: Rates of catastrophic expenditure (CE) (a cost > 10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs, and means used to meet these costs were derived. Results: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent pre-hospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (6 patients) had health insurance. 
Conclusion: Obtaining surgical care has substantial economic impacts on households which pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection. 

Details

Original languageEnglish
Article numbere039049
Number of pages9
JournalBritish Medical Journal Open
Volume11
Issue number3
Publication statusPublished - 8 Mar 2021