Trial reportBMC health services research2022
Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda.
Trial report in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis.PloS one · 2023Pooled it
- Health insurance and the distribution of healthcare use in Rwanda's Vision Umurenge Programme: evidence from the Seventh Integrated Household Living Conditions Survey.Global health action · 2026Article
- Assessing intervention effects on healthcare-related financial protection in low- and middle-income countries: a rapid evidence review.Health policy and planning · 2026Review
- Domestic resources for surgical care financing: a descriptive analysis of global health expenditure trends and illustrative case studies on fiscal mechanisms in LMICs.BMJ global health · 2026Article
- Conventional versus enhanced recovery laparoscopic cholecystectomy in Rwanda: A comparative analysis of costs and clinical outcomes.Surgery open science · 2026Article
- Exploring the lived socioeconomic experiences of teen mothers in Rwanda.Reproductive health · 2026Article
- Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data.BMJ global health · 2024Article
- Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review.PLOS global public health · 2024Article
- Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda.Surgical infections · 2023Article
- Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania.Frontiers in pediatrics · 2023Article
- Measuring the Uptake of Growth Monitoring and Nutrition Promotion among under-5 Children: Findings from the Rwanda Population-Based Study.Children (Basel, Switzerland) · 2022Article
- Adopting social health insurance in Nepal: A mixed study.Frontiers in public health · 2022Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundThe implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family's financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE).
methodsThis study is nested in a larger randomized controlled trial of women undergoing cesarean section at a district hospital in Rwanda. Eligible patients were surveyed at discharge to quantify household income and routine monthly expenditures and direct and indirect spending related to the hospitalization. This was used in conjunction with hospital billing records to calculate the rate of catastrophic expenditure by insurance group.
resultsAbout 94% of the 340 women met the World Bank definition of extreme poverty. Of the 330 (97.1%) with any type of health insurance, the majority (n = 310, 91.2%) have CBHI. The average OOP expenditure for a cesarean section and hospitalization was $9.36. The average cost adding transportation to the hospital was $19.29. 164 (48.2%) had to borrow money and 43 (12.7%) had to sell possessions. The hospital bill alone was a CHE for 5.3% of patients. However, when including transportation costs, 15.4% incurred a CHE and including lost wages, 22.6%.
conclusionTo ensure universal health coverage (UHC), essential surgical care must be affordable. Despite enrollment in universal health insurance, cesarean section still impoverishes households in rural Rwanda, the majority of whom already lie below the poverty line. Although CBHI protects against CHE from the cost of healthcare, when adding in the cost of transportation, lost wages and caregivers, cesarean section is still often a catastrophic financial event. Further innovation in financial risk protection is needed to provide equitable UHC.
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