A. Yap3, M. Cheung2, N. Kakembo1, P. Kisa1, A. Muzira1, J. Sekabira1, D. Ozgediz2 1Makerere University,Department Of Surgery,Kampala, , Uganda 2Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 3Yale University School Of Medicine,New Haven, CT, USA
Background: Universal health coverage with financial risk protection is a target for the United Nations Sustainable Development Goals (SDGs). Catastrophic health expenditure (CHE) is usually defined as patient healthcare spending of >10% of total household expenditure, or >40% of household expenditure after food expenses. 90% of global CHE occurs in low-income countries; however, CHE data for pediatric surgical conditions in low-income countries is limited. While public hospitals provide free care, patients accrue substantial expenses. Our prior focus group discussions with families in Uganda have highlighted an alarming economic burden, but these have not been studied further. We sought to calculate out-of-pocket (OOP) expenditure accrued by families with children undergoing surgery at the national referral hospital in Kampala, Uganda, one of two Ugandan centers with a dedicated pediatric surgery unit.
Methods: In this cross-sectional study, 132 families receiving inpatient care at Mulago Hospital Department of Pediatric Surgery were included through prospective convenience sampling from November 2016 to April 2017. From prior work, a survey tool was designed including expenses for transport, diagnostic tests, medications, food and lodging, and productivity losses. The tool was pilot tested, revised, and validated. Loans and pawned possessions were also collected from a subset of participants. Ugandan shillings were converted into US dollars using purchasing power parity.
Results: Median transportation cost was $26.63. Median OOP medication cost was $18.37, and median cost for diagnostic tests was $27.55. The median amount spent on food and lodging per visit per family was $32.60. 88 (67% of) participants responded to questions on loans and sold items: 19% borrowed money and 9% sold items to fund the hospital visit. For those with employed family members staying in the hospital, median household productivity loss was $95.52. Total median expense per visit per family amounted to $150.62. Using the average annual household expenditure in Uganda ($2694) as reference, 31.8% of households face catastrophic spending for a single inpatient hospital stay.
Conclusions: Though pediatric surgical services in Uganda are formally provided for free by the public sector, families pay for transportation, lodging, and medical costs due to public resource shortages. Households also accrue productivity loss from workdays spent in the hospital and almost a third of households incur catastrophic expenditure for a single pediatric surgical procedure. This study suggests that broader financial protection must be established to meet SDG targets.
