ReviewThe Pan African medical journal2021
Challenges in healthcare financing for surgery in sub-Saharan Africa.
Review in The Pan African medical journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Bariatric Procedures in the Sub-Saharan Africa: A Systematic Review of Patterns and Outcomes.Obesity surgery · 2025Pooled it
- Robotic and laparoscopic minimally invasive surgery for colorectal cancer in Africa: an outcome comparison endorsed by the Nigerian society for colorectal disorders.Surgical endoscopy · 2025Pooled it
- Non-operative versus operative management of uncomplicated acute appendicitis: a randomized controlled study in Sierra Leone.BMC surgery · 2026Trial
- Trial
- A High-Resolution Microendoscope Improves Esophageal Cancer Screening and Surveillance: Implications for Underserved Global Settings Based on an International Randomized Controlled Trial.Gastroenterology · 2025Trial
- Pediatric hydrocephalus in Nigeria: a scoping review of management, treatment outcomes, and challenges.Neurosurgical review · 2026Article
- Evaluating the Impact of Financial Navigation on Financial Catastrophe and Distress for Cancer Care: A Randomized Control Trial- COST-FIN.Research square · 2026Article
- Household costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care in rural Ethiopia.PloS one · 2026Article
- Perceptions of facilitators, barriers and adaptations for provision of obstetric fistula surgery and care: a qualitative descriptive study of service providers in selected hospitals in Busoga sub-region, eastern Uganda.Frontiers in global women's health · 2026Article
- Impact of a Mobile Money-Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study.JMIR mHealth and uHealth · 2025Article
- Exploring machine learning classification for community based health insurance enrollment in Ethiopia.Frontiers in public health · 2025Article
- Trapped by debt: an ethnographic study of medical indebtedness and hospital detention in the Fundong Health District, Cameroon.Frontiers in public health · 2025Article
- Psychosocial Experiences of Adults With Lower Limb Fracture in Ghana: A Qualitative Study.Journal of patient experience · 2025Article
- LC-YOLOmatch: a novel scene segmentation approach based on YOLO for laparoscopic cholecystectomy.Frontiers in artificial intelligence · 2025Article
- Ten years of ear, nose and throat (ENT) services in Southern Africa: a scoping review.Global health action · 2024Article
- Assessment of the financial gaps in cardiothoracic surgery in Africa.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Building resilient surgical systems that can withstand external shocks.BMJ global health · 2024Review
- A plea for urgent action: Addressing the critical shortage of cardiothoracic surgical workforce in the COSECSA region.World journal of surgery · 2024Article
- Persistency of catastrophic out-of-pocket health expenditures: Measurement with evidence from three African countries - Malawi, Tanzania, and Uganda.Social science & medicine (1982) · 2024Article
- Hepato-pancreato-biliary surgery in West Africa: a timely capacity assessment.HPB : the official journal of the International Hepato Pancreato Biliary Association · 2024Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors' key findings of out-of-pocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA.
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