Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

Paul Eze, Lucky Osaheni Lawani, Ujunwa Justina Agu, Yubraj Acharya

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9–20.4; 50 datapoints; 462 151 households; I2 = 99.9%) for a threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2–10.3; 84 datapoints; 795 355 households; I2 = 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed.

Original languageEnglish (US)
Pages (from-to)337-351J
JournalBulletin of the World Health Organization
Volume100
Issue number5
DOIs
StatePublished - May 1 2022

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

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