Presenter: Gwat Nazah

Twitter: Gwat Tchongla

Co-authors: Ernest L Molua

Poster file: [download]
HEALTH INSURANCE (OUT OF POCKET PAYMENTS) AND MOTHER / CHILD IMMUNIZATION IN CAMEROON Gwat Tchongla Nazah1, 2* and Ernest Molua1 1.Department of Agricultural Economics and Agribusiness, Faculty of Agriculture and Veterinary Medicine, University of Buea, P.O. Box 63 Buea, Cameroon. Tel: (+237) 675 76 01 77; Fax: (+237) 243 32 22 72. 2.Centre for Independent Development Research, P.O. Box 58 Buea, SWR, Cameroon. (* Corresponding author) 1. Introduction Immunization has been implemented in Cameroon by the Expanded Program on Immunization, (EPI) since 1981. By 1995 the target of 80% coverage was not met for vaccination. Vaccination coverage is higher now and done for free although some private and non-governmental providers charge some minimal sums. Despite the zero charges and the attempt to achieve a universal coverage by the EPI, Some persons still don’t vaccinate their children or delay vaccination. Given the profits of immunization, there is need to extend coverage, especially for rural women and children in low income countries with the highest child and maternal mortality rates. Vaccination has contributed greatly in reducing morbidity and mortality worldwide. It is estimated that vaccination helps to prevent 2 to 3 million deaths each year in Africa. In the past, in most Sub Saharan African countries, Cameroon inclusive, the burden of health expenditures among children was mostly attributed to diseases such as polio, measles, yellow fever, tuberculosis and tetanus and they constituted a majority of the public health problems. Out-of pocket payments still dominate health expenditures in many low and middle income countries driving people into the risk of poverty especially in rural areas (van Doorslaer et al. 2005). Cameroons’ national policy promotes social security, through Mutual Health. Despite this commitment, households willingly cover the direct and indirect cost of health shocks and deliveries for women. Consequently, the cost of illness affects not only sick members of households, but also healthy members indirectly. For a child to be fully immunized in Cameroon, Mothers are expected visit to visit the hospital at least 14 times for immunization purposes before their children turn 5 years old. Low health Insurance coverage and delayed or incomplete vaccination schedules are strongly correlated. Uninsured persons sometimes incur catastrophic payments and are unable to divert such funds to other basic necessities and the indirect costs which come with ensuring immunization. The study aimed to analyze the vaccination coverage, reasons for delays for non-vaccinated children and to establish the importance of health insurance as a whole and also its importance when it comes to the indirect expenditures for immunization. The findings of this study will serve to guide the national policies towards out of pocket payments, and also serve as a base for future studies in order to improve immunization among the rural poor. 2. Method This is a retrospective cross sectional study in which questionnaires were administered to some 98 mothers who visited the hospital with their babies. Secondary data was obtained from the Mutual health scheme and hospital registers This study was carried out in the Bamenda Health District of Cameroon, located in the North West Region. The North West is one of the 10 regions, making up the Republic of Cameroon and the Bamenda Health District is one of the 19 health districts in the region. From Global Position System (GPS) readings, the altitude of the area ranges from 1239.2m/19,0m to 1304.8m/19.0m.. The data was analysed using SPSS version 22 software. 3. Results REASONS FOR INCOMPLETE, DELAYED OR NON-VACCINATION (N=39) Reasons Number Percentage (%) Lack of time (queuing) 3 7.69 Forgetfulness 2 5.12 Childhood illnesses 2 5.12 Post immunization adverse events 4 10.25 Poor sensitization 4 10.25 Too occupied with work 8 20.51 Distance from home(number of drops and inconvenience) 7 17.94 Transport cost and finance 7 17.94 Poor reception of hospital personnel 1 2.56 Others 1 2.56 Several reasons were induced to explain the absence or incomplete vaccination of children, amongst which Lack of time and occupation with domestic work ranked top on the list , In Cameroon, the duty of vaccination is that the woman who, is equally charged with home or domestic work and has to cater for other children , She is a times over burdened with small businesses which she cannot forgo the proceeds on days due for vaccination of babies. Those who make it for vaccination tend to forgo the proceeds of the day’s business. This is an indirect cost. Transport cost and finance which is also an indirect cost is another factor for delays or non-vaccination. It ties with the complaint of distance and inconveniences which are all felt in a bid to get children vaccinated. Still, the low financial status of women is one of the difficulties they face in accessing health services. Some mothers go on 3months maternity leave and still tend to forget vaccination days. Some get disgruntled with long waiting time and the queues at hospital. During such long hours they get involved in unnecessary expenditures which are not directly related with getting their children vaccinated. Other factors include socio-demographic factors, sensitization and perception which negatively influence children’s vaccination. Therefore it is necessary that the hospital staff spur up women to vaccination. INDIRECT COST & SOCIO-ECONOMIC IMPACT ON UNINSURED MOTHERS Av. Monthly Income (FCFA/USD) Direct cost (FCFA/USD) Av. Indirect Cost (FCFA/USD) 32,320/ 64.64 300/ 0.6 Transport Cost 1,260/ 2.52 Opportunity Cost 4,350/ 8.7 Other Expenses on Vaccination days 825/ 1.65 TOTAL (6,435/ 12.87) Av. Income (FCFA/USD) 32,320/ 64.64 Av. Indirect Expenditure ((FCFA/USD) 6,435/ 12.87 Respondents had an Average monthly income of 32,320 FCFA or 64.64 USD, this was arrived at by summing up their incomes and dividing by their total. Mothers acknowledged incurring just about 300 FCFA or 60 cents as direct cost for vaccination. Rather, they spent up to 6,435FCFA or 12.87 USD on expenditures not directly related to Vaccination. This implies that cost for vaccination is low, but the financial burden is felt mostly due to indirect cost. Therefore uninsured mothers who suffer high direct and indirect expenditures for health services, are more impoverished than those who are insured and enjoy between 75% to 100% of their health and delivery bills covered for them. 4. Conclusion The study discovered that generally there is a less than 1% coverage and enrolment in health insurance schemes in Cameroon, which is very low. Therefore, mothers still tend to cover their entire costs for delivery and vaccination of new born, and they are not opportune to save some money from their total expenditure which is usually heavy compared to the average income. Lesser women were enrolled to schemes, making the schemes, not very effective when it comes to covering their bills. This could be catastrophic to women who have difficult deliveries especially. Uninsured women are likely to save less than insured women as 100% of the bill is covered for insured women who do not incur difficult deliveries The findings raise questions on the economic burden on women, given the necessary vaccines and medication they have to take together with their children. It is important to take into consideration the economics of mother and child care when policies are made. 5. 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