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Catastrophic health expenditure and its determinants in Kenya slum communities

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Buigut, Steven, Ettarh, Remare, Amendah, Djesika D·2015·International Journal for Equity in Health
DOI 10.1186/s12939-015-0168-9PMC PMC4438568
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Abstract

BACKGROUND: In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. METHODS: We use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. RESULTS: The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. CONCLUSION: This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.

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Research works printed but not linked: 3

  1. Candiracci S, Syrjänen R. UN-HABITAT and the Kenya Slum Upgrading Programme. Nairobi: United Nations Human Settlements Programme (UN-HABITAT); 2007.
  2. Kimani NG. Environmental pollution and impacts on public health: implications of the Dandora Municipal Dumping Site in Nairobi, Kenya. Nairobi: United Nations Environmental Programme; 2007.
  3. Maoulidi M. Kisumu millennium development goals multi-sector household survey. New York: Earth Institute, Columbia University; 2012.

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Metadata

Authors
Buigut, S., Ettarh, R., & Amendah, D. D.
Affiliations
  • American University in Dubai (AE)
  • African Population and Health Research Center (KE)
Corresponding author
Amendah, Djesika D
ORCID
Venue
International Journal for Equity in Health
Publisher
Springer Science and Business Media LLC
Published
2015-05-14
Volume
14
Issue
1
Pages
46-46
ISSN
1475-9276 (ISSN-L)
DOI
10.1186/s12939-015-0168-9
PMC
PMC4438568
OpenAlex
W2125617054
Cited by
174
References
26
Citations by year
2026: 7 · 2025: 13 · 2024: 11 · 2023: 26 · 2022: 19 · 2021: 24 · 2020: 18 · 2019: 21 · 2018: 16 · 2017: 12 · 2016: 5 · 2015: 2
FWCI
22.33
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal for Equity in Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Greater South Information System
Funders
  • Eli Lilly and Company
  • William and Flora Hewlett Foundation
  • Styrelsen för Internationellt Utvecklingssamarbete
  • African Population and Health Research Center
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
catastrophic health expenditure, out-of-pocket health payments, informal settlements, slum communities, Kenya, social safety nets, hospital care, health care access, health equity
MeSH terms
Adult, Catastrophic Illness, Health Expenditures, Female, Financing, Personal, Humans, Kenya, Male, Middle Aged, Poverty Areas, Surveys and Questionnaires, Logistic Models

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