Browsing by Author "Ataguba, John Ele-Ojo"

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    A critical assessment of the Rwandan health financing system: implications for health service utilisation
    (2025) Hakuzimana, Alex; Ataguba, John Ele-Ojo; Obse, Amarech; Cunnama, Lucy
    Like many other countries, Rwanda has embraced major health financing reforms to achieve universal health coverage goals and improve access to quality health services without undue financial hardship for its citizens. The public health sector provides most health services in the country, and fragmentation is a major challenge to its health financing system. Literature suggests that fragmentation of health financing may negatively impact the health system's equity, efficiency, and sustainability. Considering the currently available literature, this thesis critically assessed Rwanda's health financing system in relation to the equitable use of health care services, one of the goals of universal health coverage. Various methodological approaches to address different objectives are explored. A case study qualitative approach combining document review and in-depth interviews of key informants indicates that the Rwandan health financing system is fragmented. Using the data from the 2005/2006 and 2010/2011 Integrated Household Living Conditions Surveys, this research shows that despite this fragmentation and contrary to findings from other studies, there was no inequality in public health services use during the two separate periods. These results provide further opportunities for more health sector reforms to improve access to affordable public health services in Rwanda. They also support recommendations to conduct similar analyses to compare these findings with the most recent data to capture the current reality on the equitable use of health care services in public health facilities.
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    Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana
    (BioMed Central, 2017-05-22) Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di
    Background: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme. Methods: Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. Results: There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. Conclusion: It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.