Abstract

Introduction Ethiopian households’ out-of-pocket healthcare payments constitute half of the national healthcare budget. Such out-of-pocket payments pose severe financial risks, can be catastrophic, impoverishing, and one of the causal barriers for low utilisation of healthcare in Ethiopia. This study aimed to assess the financial risk of seeking maternal and neonatal healthcare in southern Ethiopia.

Methods A population-based cohort study of 794 households was conducted involving 794 pregnant and 784 postpartum women, and 772 neonates in rural kebeles of the Wonago district. The financial risk was estimated using the incidence of catastrophic healthcare expenditure, impoverishment, and depth of poverty. Annual catastrophic healthcare expenditure was determined if out-of-pocket payments exceeding 10% of total household or 40% of non-food expenditure. Impoverishment was analysed based on total household expenditure and the international poverty line of ≈ $1.9  per capita per day.

Results Approximately 93% (735) of pregnant, and 31% (244) of postpartum women, and 48% (369) of neonates experienced illness. However, only 56 households utilised healthcare services. The median total household expenditure was $527  per year (IQR=390: 370,760). The median out-of-pocket healthcare payment was $46  per year (IQR=46: 46, 92) with two episodes per household, and shared 19% of the household’s budget. The poorer households paid more than did the richer for healthcare, during pregnancy, and neonatal illness. However, the richer paid more than did the poorer during postpartum illness. Forty-six percent of households faced catastrophic healthcare expenditure at the threshold of 10% of total household expenditure, or 74% at a 40% non-food expenditure, and associated with neonatal illness (aRR: 2.56, 95%CI: 1.02, 6.44). Moreover, 92% of households were pushed further into extreme poverty and the poverty gap among households was 45 Ethiopian Birr per day.                                                                                                                               Conclusions

This study demonstrated that utilisation of maternal and neonatal healthcare in southern Ethiopia is very low and seeking such healthcare constitutes a substantial financial risk during illness among rural households. There was inequity in out-of-pocket healthcare payments and in its share of household’s budget. Therefore, the issue of health inequality and disparity should be considered when setting priorities for health equity.

Keywords

Financial risk; maternal; neonatal; southern Ethiopia; cohort study; rural households.