Medical care cost and health seeking behaviour in a rural community in Kirinyaga district.Kenya.

Abstract

A cross-sectional household survey of medical care cost and health seeking behaviour in a rural community was conducted in Kirinyaga District, Central Province , Kenya from December 1990 to January 1991. Thirteen hundred and seventy (1370) households were surveyed in order to assess morbidity, utilization of health facilities for outpatient medical care, maternity and mother child health services, and expenditure on medical care including maternity. Socio-economic (education, household income, household size etc. ) factors and epidemiolog ical factors (morbidity distri but ion) were also examined in relation to utilization of health care facili ties. Opinion regarding heal th prepayment schemes and cost- sharing was also sought. From the study, 605 (44.2) households reported an illness episode that afflicted a member of the household within a recall period of two weeks. This was extrapolated thus each person experienced 2.2 illness episodes per year. The commonest diseases that were reported (as perce i ved by the respondents) were malaria(28.3%), respiratory diseases (27.6%), gastro-intestinal diseases (18.7%), accidents (burns and traumatic injuries) (5.0%), skin diseases (3.3%), all other diseases (14.0 %) and headache(2.5 %) as a symptomatic illness. Health care facility utilization information revealed that 60% of the households had obtained outpatient services from public health facilities and 40% from non-governmental facilities (private and missionary health facilities). The public health facilities had provided maternity care to 55 % of the households xxi

of which 45 % was provided by the district hospital. The non- governmental provided maternity care to 20 % of the population and 25 % of deliveries took place at home. 89 % of the households obtain MCH care from government health facilities.

Socio-economic

and epidemiological

factors

influenced

utilization of health facilities. These includes economic status (particularly household income), type of disease and duration of illness. The proportion of households that had incurred some out-of pocket expenditure on medical care was mainly on maternity services 74.6 %, outpatient care 41.0 % and self-medication 24.6 %. They were found to have spent a mean of Ksh.8.90 (S.D. 7.1) on self administered medicines obtained from the local shops, Ksh. 78.20 (S.D.72.0), on prescriptions bought from the chemist and Ksh. 43.70 (S.D.38.0) on routine laboratory investigations. The households that paid money for butpatient treatment in both public and fee-for services facilities, incurred a mean of Ksh.62.70 (S.D 72.50). Mean maternity cost was Ksh.199.50 S.D.297.70 and this was mainly in form of fees. Annual estimate of medical expenditure by households was as follows: Self-medications Ksh. 231.40 (S.D.187)

Prescriptions Laboratory Outpatient Maternity

Ks h . 2033 (S.D. 1872) Ks h . 1630.20 (S.D. 1885) Ksh. 1136.20 (S.D. 988) Ksh. 197.20

Expenditure on maternity services was highly skewed. Income from regular household economic activities was found xxii

to have a significant influence on the choice of the place of delivery of children (Chi-squared = 45.92589 D.F.8,P-value 0.0000 < 0.05). Expenditure on outpatient services was not influenced by salary or wage income. However there was a significant spending across the different income groups, that higher income categories spent more money for outpatient than those in lower income.

(Chi-squared = 17.15229 D.F 8 P-value 0.0286 < 0.05).

Only about 11.0 % of the households were enroled into a medical insurance scheme and these were mainly enroled with the compulsory National Health Insurance Fund (N.H.I.F.).

There was an overwhelming posi ti ve response

76.0 %)

towards the health pre-payment scheme discussed with the respondent ( s ). Most household respondents did not favour the idea of cost-sharing (user- fees) in government health fac il it ies. They expressed various reasons for not favouring cost-sharing. Among the prominent reasons was that the government should provide free health services (47.0 %), that people are paying taxes (19.1 %) and that drugs are always in short supply in these facilities (26.7 %). However on enquiry into what are the necessary conditions to be fulfilled for cost-sharing to be appropriate, it was observed that adequate drug supply was very crucial.

The study recommended that a Rural Heal th Insurance Fund can form the backbone for a viable long-term financing of the increasingly expensive health care to the rural community and thus supplement the government's effort in the improvement of public health services.