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Out-of-Pocket Payments, Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective

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  • Michael N Onah
  • Veloshnee Govender

Abstract

Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.

Suggested Citation

  • Michael N Onah & Veloshnee Govender, 2014. "Out-of-Pocket Payments, Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-11, April.
    • Handle: RePEc:plo:pone00:0093887
    DOI: 10.1371/journal.pone.0093887
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    References listed on IDEAS

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    1. Onah, Michael Nnachebe & Horton, Susan, 2018. "Male-female differences in households' resource allocation and decision to seek healthcare in south-eastern Nigeria: Results from a mixed methods study," Social Science & Medicine, Elsevier, vol. 204(C), pages 84-91.
    2. Rodela, Tahmina Tasnim & Tasnim, Samia & Mazumder, Hoimonty & Faizah, Farah & Sultana, Abida & Hossain, Md Mahbub, 2020. "Economic Impacts of Coronavirus Disease (COVID-19) in Developing Countries," SocArXiv wygpk, Center for Open Science.
    3. Oliver Kaonga & Charles Banda & Felix Masiye, 2019. "Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-14, April.
    4. Murphy, Adrianna & Kowal, Paul & Albertini, Marco & Rechel, Bernd & Chatterji, Somnath & Hanson, Kara, 2018. "Family transfers and long-term care: An analysis of the WHO Study on global AGEing and adult health (SAGE)," The Journal of the Economics of Ageing, Elsevier, vol. 12(C), pages 195-201.
    5. Kim, Tae Jun & Vonneilich, Nico & Lüdecke, Daniel & von dem Knesebeck, Olaf, 2017. "Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries," Social Science & Medicine, Elsevier, vol. 176(C), pages 158-165.

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