Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana

Sekwati, Banyana

Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Division of Public Health

Faculty

Faculty of Health Sciences

Abstract

Out-of-pocket (OOP) health expenditures can place a heavy financial strain on households, often resulting in catastrophic healthcare costs and driving families into poverty. This thesis assesses the extent to which OOP health costs impact households in Botswana because of healthcare utilization. The study is divided into four main sections. Part A: Literature Review provides an overview of key concepts, theoretical frameworks, and empirical evidence related to catastrophic and impoverishing health expenditures. It explores regional and international studies on the financial hardships caused by OOP healthcare costs. Part B: The manuscript presents the main research findings, utilizing data from the nationally representative Botswana Multi-Topic Household Survey 2015/16, conducted by Statistics Botswana, which includes a sample of 7,049 households. Catastrophic and impoverishing OOP healthcare payments were evaluated using a threshold that varies according to household income. Impoverishment was measured using Botswana's national poverty line of BWP 1,014.00/month and the international poverty line of $1.90 per day. The findings reveal that 13.8% of households in Botswana experienced financial hardship when applying a threshold of 10% of total consumption expenditure. In comparison, 3.1% faced financial hardship using a 40% threshold of non-food expenditure. Additionally, approximately 0.1% of households— equivalent to around 122,588—were pushed below the poverty line based on Botswana's national poverty line. In Part C: Policy Brief, the study's conclusions are summarized into actionable recommendations for policymakers. It advocates for strategies such as the establishment of a national health insurance scheme to enhance financial protection and ensure equitable access to healthcare services. The final section includes Appendices, which provide the study protocol, research instruments used for data collection and analysis, and ethical clearance. The findings from this thesis contribute to the ongoing discourse on universal health coverage in Botswana by offering evidence-based insights into the financial barriers to accessing healthcare. The policy recommendations aim to inform health financing reforms that mitigate the adverse effects of OOP payments while promoting equitable access to healthcare services.

Keywords

health expenditure

Botswana

Reference:

Collections

Masters

Full item page