Economic Burden of Illness among the Self-Employed in the Commercial City of Port-Harcourt

Main Article Content

Ikeokwu E. Anderson
Foluke O. Adeniji

Abstract

Introduction: The informal sector in Port-Harcourt harbours the small-scale and self-employed activities which are mainly for generating employment and incomes. Self-employed activities in Port-Harcourt is huge and well spread, which contributes over 50% of the state Gross Domestic Product. Even though the informal sector is an opportunity for generating reasonable incomes for many people, most informal workers are without secure income, employments benefits and social protection. For this they often face health related shocks, such as unpredictable illnesses that weaken their health status. This results into massive loss of income but also meagre resources that has been in a hard way saved over a long period of time. This study investigated the economic burden of illness among the self-employed in Port-Harcourt, Rivers State, in addition to the mechanisms that self-employed individuals used to pay for health services and cope with payments.

Methodology: This study was a cross-sectional descriptive in design which comprises of 204 self-employed individuals who were selected from seven different trade association in Port-Harcourt using asemi-structured interviewer-administered pre-tested questionnaire. A Socio-economic Status (SES) index was used to divide the households into quintiles, and ANOVA test was used to test for significant differences in the mean cost of illness by SES quintiles. Data collected were analysed using the statistical package for social science (SPSS), version 23 software.

Results: The results show that malaria was the illness most people had. The total cost of illness was ₦4602.93 ± 13194.072 ($12.7US) per month with Malaria contributing 102(50%) most recent self-reported cause of illness and most 145(71.0%) seeking treatment highlighted that their choice of healthcare provider are the patent medicine vendor popularly known as chemist. Total direct cost of illness accounted for 72.7% of the total cost of illness and 3.8% of income per month while the total indirect cost of illness accounted for 27.30% of the total cost of illness and 1.40% of income per month also the total cost of illness for respondents amounted to 6% of the poorest quintile monthly income, 1.8% for those in the poor quintile, 4.2% for those in the middle quintile, 6.2% for those in the rich quintile, while 7.5% for those in the richest quintile.

Conclusion: From the study findings, patent medicine vendor (chemist) was the most utilized in terms of choice of healthcare provider due to that the large cost of health care, in which this certain choice of healthcare provider (chemist) provides them with alternatives such as avoiding consultation fees and flexibility of payment, but most of this chemist lack training in the holistic approach towards healthcare and delivery, with their sole aim of maximizing profit rather than improving health outcomes, thereby endangering their clients by predisposing them to catastrophic health expenditure, because of frequent visit due to unrecovered health problems. To improve health outcomes and decrease the level of poverty due to catastrophic health expenditure, the nation health system should incorporate this certain group of health provider into the health system where they could be trained in topics such as; first aid care, referral system also strict policies on regulating their operation needs to be regulated and monitored adequately. Also, to attain universal health coverage with quality health services, introduction of cost sharing schemes is of dire need among the informal sector. These schemes create affordable healthcare at the time of sickness, thereby reducing the incidence of out-of-pocket payment which act as the main barrier in accessing healthcare.

Keywords:
Informal, self-employed, out-of-pocket, Port-Harcourt.

Article Details

How to Cite
E. Anderson, I., & O. Adeniji, F. (2019). Economic Burden of Illness among the Self-Employed in the Commercial City of Port-Harcourt. South Asian Journal of Social Studies and Economics, 5(3), 1-13. https://doi.org/10.9734/sajsse/2019/v5i330145
Section
Original Research Article

References

Carrin G, Waelkens MP, Criel B. Community-based health insurance in developing countries: A study of its contribution to the performance of health financing systems. Tropical Medicine and International Health. 2005;10(8):799– 811.

Uzochukwu B, Ughasoro MD, Etiaba E, Okwuosa C, Envuladu, Onwujekwe OE. Healthcare financing in Nigeria: Implication for achieving universal health coverage. Niger J Clin Pract. 2015;18:437-44.

O‟Donnell O, Van Doorslaer E, Rannan-Eliya R, Somanathan A, Adihkari S, Akkazieva B. Who pays for health care in Asia? Journal of Health Economics. 2008; 27:460–475.

WHO. World Health Statistics, Geneva: World Health Organization; 2004.

Goudge J, Russell S, Gilson L, Gumede T, Tollman S, Mills A. Illness-related impoverishment in rural South Africa: Why does social protection work for some households but not others? J Int Dev. 2009;21:231-51.

Wagstaff A, Van Doorsaler E. Equity in healthcare financing and delivery. In: Culyer AJ, Newhouse JP, editors. Handbook of Health Economics. 1st ed., Vol. B. Ch. 34. North Holland: Elsevier. 2000;1803-62.

Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu BS. Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries. Trop Med Int Health. 2011;16: 1334-41.

WHO. The World Health Report - Health systems financing: The path to universal coverage. Geneva: The World Health Organization; 2010.

Soyibo A. National health accounts of Nigeria, 1998-2002. Ibadan: University of Ibadan, Nigeria; 2004.

Rivers State Tax Report. A Research on Taxation in the Informal Sector in Rivers State; 2017.

Kio-Lawson D,Dekor JB. Port Harcourt, the Garden City: A Garden of Residents Nightmare World Environment. 2014;4(3): 111-120.

Ogbonna DN, Amangabara GT, Ekere TO. Urban solid waste generation in Port Harcourt metropolis and its implications for waste management. Management of Environmental Quality: An International Journal. 2007;18(1).

National Population Commission (NPC) [Nigeria], ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; 2014.

Rivers Population Statistics. City Population. de; 2011.
(Retrieved 16 August 2017)

Onwujekwe O, Okereke E, Onoka C, Uzochukwu B, Kirigia J, Petu A. Willingness to pay for community-based health insurance in Nigeria: Do economic status and place of residence matter? Health Policy and Planning, Oxford University Press in association with The London School of Hygiene and Tropical Medicine; 2009.

Araoye MO. Research methodology with statistics for health and social sciences. Ilorin. Nathandex Publishers. 2003;119-120.

Central Bank of Nigeria Exchange Rate; 2017.
(Accessed on 10/11/2017)

Fahmida Chowdhury. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh; 2016.

Stephen B, Chandiwana B, Munyati S, Chirwa Y, Mashange W, Chandiwana P, Fustukian S, McPake B. Impact of user fees on health care seeking behaviour and financial protection during the crisis period in Zimbabwe: A life history approach. Rebuild RPC Working Paper; 2016.

Onwujekwe O, Onoka C, Uguru N, Tasie N. Socio-economic and geographic differences in acceptability of community-based health insurance. Public Health. 2011;125(11):806.

Onwujekwe O. Research for development willingness to pay for community-based health insurance in Nigeria: Do economic status and place of residence matter? Health Policy and Planning. 2012;25(2): 155-161.

Melaku H, Shimeles O, Berhane M. Willingness to join community-based health insurance among rural households of Debub Bench District, Bench Maji Zone, Southwest Ethiopia, BMC Public Health. 2014;14:591

Nadia IA, Stephen PL. Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh.BMC Public Health. 2010;10:622.

Rubana I, Rocco P, Akib K, Syed Jafar R R, Shakil AT, Ahmed, Alayne MA. The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: A GIS study; BMC Pregnancy Childbirth. 2016;16(1): 240.