Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective

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dc.contributor.authorOnah, Michael Nen_ZA
dc.contributor.authorGovender, Veloshneeen_ZA
dc.date.accessioned2015-11-11T14:27:48Z
dc.date.available2015-11-11T14:27:48Z
dc.date.issued2014en_ZA
dc.description.abstractOut-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.en_ZA
dc.identifier.apacitationOnah, M. N., & Govender, V. (2014). Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective. <i>PLoS One</i>, http://hdl.handle.net/11427/14925en_ZA
dc.identifier.chicagocitationOnah, Michael N, and Veloshnee Govender "Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/14925en_ZA
dc.identifier.citationOnah, M. N., & Govender, V. (2014). Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective. PloS one, 9(4), e93887. doi:10.1371/journal.pone.0093887en_ZA
dc.identifier.ris TY - Journal Article AU - Onah, Michael N AU - Govender, Veloshnee AB - 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. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0093887 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective TI - Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective UR - http://hdl.handle.net/11427/14925 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14925
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0093887
dc.identifier.vancouvercitationOnah MN, Govender V. Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective. PLoS One. 2014; http://hdl.handle.net/11427/14925.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2014 Onah, Govenderen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHealth economicsen_ZA
dc.subject.otherSocioeconomic aspects of healthen_ZA
dc.subject.otherNigeriaen_ZA
dc.subject.otherDemographyen_ZA
dc.subject.otherHealth services researchen_ZA
dc.titleOut-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspectiveen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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