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

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dc.contributor.advisorAlaba, Olufunke
dc.contributor.authorSekwati, Banyana
dc.date.accessioned2026-07-21T09:46:58Z
dc.date.available2026-07-21T09:46:58Z
dc.date.issued2026
dc.date.updated2026-07-21T09:44:03Z
dc.description.abstractOut-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.
dc.identifier.apacitationSekwati, B. (2026). <i>Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of Public Health. Retrieved from http://hdl.handle.net/11427/43626en_ZA
dc.identifier.chicagocitationSekwati, Banyana. <i>"Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of Public Health, 2026. http://hdl.handle.net/11427/43626en_ZA
dc.identifier.citationSekwati, B. 2026. Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana. . University of Cape Town ,Faculty of Health Sciences ,Division of Public Health. http://hdl.handle.net/11427/43626en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Sekwati, Banyana AB - 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. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - health expenditure KW - Botswana LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana TI - Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana UR - http://hdl.handle.net/11427/43626 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43626
dc.identifier.vancouvercitationSekwati B. Assessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana. []. University of Cape Town ,Faculty of Health Sciences ,Division of Public Health, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43626en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDivision of Public Health
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjecthealth expenditure
dc.subjectBotswana
dc.titleAssessing catastrophic and impoverishing health expenditure from out-of-pocket health payments in Botswana
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPH
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