Forgoing Healthcare Services: Evidence from a Household Survey in Abidjan (Côte d’Ivoire)

Abstract

<i>Background</i>: In Africa, healthcare is generally supported by households. The heavy burden of healthcare on household leaders can lead them to forego care. In this study, we analysed the determinants of healthcare renunciation among household leaders in Abidjan. <i>Methods</i>: This cross-sectional study was carried out from May to July 2019 in "colombie", a neighbourhood of Abidjan (Côte d’Ivoire). Heads of household that had been living there for at least 3 months were randomly selected. Sociodemographic, economic, health status and health care renunciation characteristics were collected. Logistic regression models were used. <i>Results:</i> The sample consisted of 648 heads of household with a mean age of 35.6 ± 8.37 years and a sex ratio (F/M) of 1.59. Almost all of them (97.53%) had given up care at least once. Medical consultations foregone concerned 57.56% of them (including 18.21% to the general practitioner and 39.35% to the specialist). After the consultation, 39.97% of them gave up on other care. People who reported poorer health (OR= 1.93 [1.14–3.29], p=0.015) and those who had no health coverage (OR=6.42 [3.90–11.00], p<0.001) gave up significantly more medical consultations. Heads of households with dependent children (OR=1.93 [1.15–3.34], p=0.015), those who were still in school (OR=1.89 [1.06–3.36, p=0.030]) and those without health insurance (OR=3.30 [1.80–6.19], p<0.001) were significantly more likely to forego postconsultation care. <i>Conclusion:</i> Literacy level, risk perception, health system responsiveness and health insurance coverage were drivers of healthcare renunciation. Health insurance coverage was the factor that most influenced renunciation at different stages of the care pathway. As a large number household leaders don’t benefit from health insurance, this work highlights the need to make health coverage functional in the country.