Uptake of paediatric surgical interventions in the face of catastrophic health expenditure and a declining global economy

Abstract

Out-of-pocket payment for surgical care exposes many households in low- and middle-income countries to catastrophic health expenditure. Children requiring common elective surgical intervention may therefore experience substantial delay in accessing treatment as a result of this. This study assesses the risk of catastrophic health expenditure, and factors associated with delayed surgical intervention in children among families attending a free pediatric surgical outreach programme. A cross-sectional study was conducted among caregivers of children who received free surgery during a free surgical outreach. Information on household income, food expenditure, prior healthcare financing, and previous delays to treatment were obtained using interviewer-administered questionnaires. Catastrophic health expenditure was defined as health expenditure exceeding 10% of total annual household income, and descriptive statistical analysis done. A total of 151 respondents were analyzed. Herniotomy accounted for 91.3% of procedures. The mean age at presentation was 6.63 years. Delay in obtaining surgery was reported by 63.6% of caregivers, with financial constraint being the most frequent reason. Most households relied on out-of-pocket payments (81.6%), while insurance utilization was limited. If out-of-pocket payment had been required, 60.3% of families may have been at risk of exceeding the catastrophic health expenditure threshold. This study demonstrates financial vulnerability among families seeking paediatric surgical care, characterized by low level of healthcare insurance coverage and utilization, with continued reliance on out-of-pocket healthcare payments. Findings from this study highlight the important role of free surgical outreach programmes in reducing unmet surgical needs and mitigating the immediate financial burden associated with paediatric surgical care. However sustainable long-term solutions will require expansion of effective health insurance coverage, strengthening of referral systems, and improving the availability of pediatric surgical services especially in underserved areas.