Out-of-Pocket Expenditure on Delivery Care in Public and Private Health Sectors - A Study in a Rural District of Pakistan
| Autor | Sohail Akhtar, Zafar Ahmed, Kesavan Sreekantan Nair, Yasir Hayat Mughal, Asim Mehmood |
| Cargo | Qassim University, Saudi Arabia/Universiti Malaysia Sarawak, Malaysia/Qassim University, Saudi Arabia/Qassim University, Saudi Arabia/Jazan University, Saudi Arabia |
| Páginas | 121-136 |
Volume 11 - Issue 54
/ June 2022
121
htt ps: // w ww.a maz onia inve sti ga.i nfo I SSN 232 2- 630 7
DOI: https://doi.org/10.34069/AI/2022.54.06.12
How to Cite:
Akhtar, S., Ahmed, Z., Sreekantan Nair, K., Mughal, Y.H., & Mehmood, A. (2022). Out-of-Pocket Expenditure on Delivery Care in
Public and Private Health Sectors – A Study in a Rural District of Pakistan. Amazonia Investiga, 11(54), 121-136.
https://doi.org/10.34069/AI/2022.54.06.12
Out-of-Pocket Expenditure on Delivery Care in Public and Private
Health Sectors – A Study in a Rural District of Pakistan
Perbelanjaan Luar Poket untuk Penjagaan Penghantaran di Sektor Kesihatan Awam dan
Swasta – Kajian di Daerah Luar Bandar Pakistan
Received: June 7, 2022 Accepted: July 12, 2022
Written by:
Sohail Akhtar51
https://orcid.org/0000-0002-3882-3200
Zafar Ahmed52
https://orcid.org/0000-0002-6609-7314
Kesavan Sreekantan Nair53
https://orcid.org/0000-0002-2664-2621
Yasir Hayat Mughal54
https://orcid.org/0000-0001-8862-4608
Asim Mehmood55
https://orcid.org/0000-0003-2343-7283
Abstract
Pakistan witnessed a significant improvement in maternal health outcomes during the past two decades.
However, persistent urban-rural and socio-economic inequalities exist in access to maternal healthcare
services across the country. The objective of this study was to estimate out-of-pocket expenditure (OOPE)
on delivery care by women in the public and private health sectors in RajanPur district. This was a cross-
sectional study conducted, among 368 randomly selected mothers who had childbirths from 1st October to
31st December 2020. The study applied multi-stage random sampling technique to select the study
participants. The results showed that about two-thirds of mothers preferred public hospitals for most recent
delivery. The percentage of cesarean deliveries conducted in private hospitals (43.8%) was 4.7 times higher
than in public hospitals (9.3%). About 99% of mothers incurred OOPE during delivery care, and the mean
OOPE incurred during delivery care was PKR 2840 (US$ 17.75) in public hospitals and PKR 25596
(US$159.9) in private hospitals. OOPE on cesarean delivery in private hospitals (PKR 39654.7, US$247.8)
was 2.5 times higher than the public hospitals (PKR16111.9, US$100.69), whereas OOPE incurred on
normal delivery care in private hospitals (PKR14339, US$89.62) was 9.5 times higher than OOPE in public
hospitals(PKR 1501.4, US$9.38).To conclude, the findings and recommendations drawn from the research
would provide some insights to health policymakers and planners in developing an integrated and viab le
maternal healthcare program in Pakistan.
Keywords: Delivery care, out-of-pocket expenditure, public health sector, private health sector, Pakistan.
Abstrak
Pakistan menyaksikan peningkatan ketara dalam hasil kesihatan ibu sepanjang dua dekad yang lalu. Walau
bagaimanapun, ketidaksamaan bandar-luar bandar dan sosio-ekonomi yang berterusan wujud dalam akses
kepada perkhidmatan penjagaan kesihatan ibu di seluruh negara. Objektif kajian ini adalah untuk
menganggarkan perbelanjaan out-of-pocket (OOPE) untuk penjagaan bersalin oleh wanita dalam sektor
51
Faculty of Medicine and Health Sciences UNIMAS, Universiti Malaysia Sarawak, Malaysia. Department of Health Informatics,
College of Public Health and Health Informatics, Qassim University, Saudi Arabia.
52
Faculty of Medicine and Health Sciences UNIMAS, Universiti Malaysia Sarawak, Malaysia.
53
Department of Health Administration, College of Public Health and Health Informatics, Qassim University, Saudi Arabia.
54
Department of Health Administration, College of Public Health and Health Informatics, Qassim University, Saudi Arabia.
55
Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Saudi Arabia.
122
www .am azon iai nves tiga .inf o I SSN 232 2- 6307
kesihatan awam dan swasta di daerah Rajan Pur. Ini adalah kajian keratan rentas yang dijalankan, antara
368 ibu yang dipilih secara rawak yang bersalin dari 1 Oktober hingga 31 Disember 2020. Kajian ini
menggunakan teknik persampelan rawak berbilang peringkat untuk memilih peserta kajian. Keputusan
menunjukkan bahawa kira-kira dua pertiga dar ipada ibu memilih hospital awam untuk bersalin terbaharu.
Peratusan bersalin secara cesarean yang dijalankan di hospital swasta (43.8%) adalah 4.7 kali lebih tinggi
daripada di hospital awam (9.3%). Kira-kira 99% ibu mengalami OOPE semasa penjagaan bersalin, dan
purata OOPE yang ditanggung semasa penjagaan bersalin ialah PKR 2840 (US$ 17.75) di hospital awam
dan PKR 25596 (US$159.9) di hospital swasta. OOPE untuk bersalin secara caesar di hospital swasta (PKR
39654.7, AS$247.8) adalah 2.5 kali lebih tinggi daripada hospital awam (P KR16111.9, AS$100.69),
manakala OOPE ditanggung untuk penjagaan bersalin biasa di hospital swasta (PKR14339, AS$89.62 kali)
lebih tinggi daripada OOPE di hospital awam (PKR 1501.4, AS$9.38). Sebagai kesimpulan, penemuan dan
cadangan yang diperoleh daripada penyelidikan itu akan memberikan beberapa pandangan kepada
penggubal dasar kesihatan dan perancang dalam membangunkan program penjagaan kesihatan ibu yang
bersepadu dan berdaya maju di Pakistan.
Kata kunci: Penjagaan penghantaran, perbelanjaan di luar poket, sektor kesihatan awam, sektor kesihatan
swasta, Pakistan
Introduction
Maternal health is considered a significant public
health challenge in most developing countries
(WHO, 2015). About 295 000 women in the
world died owing to reasons associated with
pregnancies and delivery in 2017 (WHO, 2017).
There is a lack of adequate healthcare services for
millions of women in developing countries,
which results in poor overall health in women
(WHO, UNICEF, 2013). Besides, there are many
barriers, including physical distance, out-of-
pocket expenditures (OOPEs), and familial
influences. (Riaz et al., 2015). Whereas poor
functionality of health centers in rural areas is
another significant barrier.
Pakistan has a population of 200 million in 2017,
with 61% living in rural areas (PBS, 2018).
Health indicator s for Pakistan are by no means
satisfactory. The country has an under-five
mortality rate of 74.9 per 1000 live births against
the global average of 39 (WHO, 2019). The
MMR of 178 per 100,000 live births is the
highest among the neighboring countries. (WHO,
2019. According to the World Bank, 29.5 %
population lives below the poverty line (World
Bank, 2019).It is estimated that 80% of the poor
population in Pakistan lives in rur al areas.
(Mansuri et al., 2018).The poor, particularly in
rural areas with lower incomes, poor sanitary
living conditions, and low access to public
healthcare, are likely to have high morbidity and
mortality rates but tend to have lower utilization
of healthcare services than those who are better
off (WHO, 2021). They also spend higher
proportions of their incomes on healthcare that
they access (WHO & World Bank, 2019).
Uncertainty related to health and the catastrophic
nature of health expenditures often renders even
non-poor households into cycles of poverty
(WHO, 2018; WHO & World Bank, 2019).
In rural areas of Pakistan, there is limited
availability of healthcare facilities. So achieving
equity in health is one of the significant goals to
improve the poor's well-being and survival in
rural areas. However, achieving equity is far
from reality, particularly with rapid privatization
that has taken healthcare beyond the reach of the
poor. Even though these services were fraught
with issues in terms of access and quality, the
poor could still find it difficult to access health
care services, including maternal and postnatal
services. Due to reasons like lack of access and
distance to government health facilities followed
by an inadequate supply of medicines and
diagnostic facilities in public healthcare
facilities, especially in rural areas, people seek
treatment in the private sector, which is the
dominant source of care, including maternal and
child health services (Pomeroy, Koblinsky&
Alva, 2014). The existing studies and reports in
different districts in Pakistan have revealed that
the private sector provides about 80% of all
outpatient contacts (PBS, 2018; Rehman et al.,
2017). Even sudden and catastrophic
expenditures can push families below the poverty
line (ADB, 2012; WHO & World Bank, 2019).
Expenditure on drugs accounted for a substantial
percentage of household expenditure in general
and health care expenditure in particular.
The past decade witnessed a significant
improvement in maternal health outcomes in
Pakistan. Although all provinces in Pakistan have
made progress in improving the maternal
mortality rate (MMR), infant mortality rate
(IMR), and under-five mortality rate (U5MR),
Akhtar, S., Ahmed, Z., Sreekantan Nair, K., Mughal, Y.H., Mehmood, A. / Volume 11 - Issue 54: 121-136 / June, 2022
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