Household Catastrophic Health Expenditure

Background: Fairness in financial contribution for health was determined by WHO (World Health Report, 2000) as the third goal of health systems which is measured by fairness in financial contribution index (FFCI). The aim of this study was to estimate FFCI and quantify extent of catastrophic household heath expenditures."nMethods: We conducted a descriptive study during May 2008. Subjects were chosen by "Systematic Random sampling" among residents of Maskan's population- based research center (Maskan Center) in Kermanshah, Iran. After complet­ing in­formed consent form, we collected data using a questionnaire by interview with head of family. In order to describing data and estimating FFCI, we used descriptive statistics and WHO methodology, respectively. Households with catastrophic expendi­tures and impoverished households were defined as those with health expenditures over 40% and 50% of their abil­ity to pay, respectively."nResults: The mean age of head of families was 48.96±12.86 years. From 189; 12.7% of household's heads were female. 75.1% of households were covered by at least one health insurance scheme. FFCI was 0.57. The proportion of house­holds fac­ing catastrophic health expenditures was 22.2% (95% CI=16.3%-28.1%)."nConclusion: The rate of FFCI among participants implied an inequality in health financing contribution. In addition, many of households (22.2%) faced catastrophic health expenditures while according to WHO estimation, the figure in the whole coun­try was 2% in 1999. Our study revealed the importance of protecting households against the costs of ill-health

Non-financial incentives and professional health workers’ intentions to stay in public district hospitals in Rwanda: A cross-sectional study

Background: Evidence shows that human resources represent a pillar that supports the healthcare system. As a result, retaining the health workforce has been considered to be a way of significantly improving of the quality of healthcare services. However, the challenge of retaining the health workforce has been an issue of concern in Rwanda. The purpose of this study was to assess the level of availability and provision of non-financial incentives, and their association with professional health workers’ intentions to stay in public district hospitals. Methods: A cross-sectional survey research design with a quantitative approach was used.  With a population of 469 health workers from four district hospitals in Kigali, Rwanda, the study used a sample of 252 individuals. The study measured the perceived levels of variability and provision of working conditions, training and development, career development opportunities, and intentions to stay. Logistic regression was used to show associations between predictors and the outcome variable with 95% confidence intervals. Results: The findings of the study show significant associations between predictors and the outcome variable. In fact, average and high perceptions on working conditions are associated with professional health workers’ likelihood of staying in the hospital (OR: 9.70, P&lt;0.001 and OR: 5.77, P=0.001, respectively). Similarly, an average and high level of perception on the availability of career development opportunities is a predictor of intention to stay (OR: 13.98, P&lt;0.001 and OR: 12.26, P=0.038, respectively). In the same view point, there is a likelihood that health workers who perceive high level of training will stay (OR 1.025; P=0.014). Conclusion: There is evidence of significant associations between predictors and the outcome variable. However, the current status of non-financial incentives may adversely affect health workers’ intentions to stay.</ns4:p