Spatiotemporal variation and socioeconomic factors of financial hardships of out-of-pocket health expenditure in Pakistan

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan\u27s four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans.Aims: In this paper, we estimate financial hardship of OPHE in Pakistan.Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% of non-subsistence expenditure. We estimate impoverishment of OPHE using national poverty lines. Finally, we explore socioeconomic factors of financial hardships of OPHE.Results: Over the years, catastrophic headcount and impoverishment of OPHE had decreased at national level (-1.3% points) and in the provinces of Sindh (-7.8% points) and Khyber Pukhtoonkhawa (KPK), (-2.8% points). The province of KPK and the year 2005-06 witnessed the highest incidence of financial catastrophe (26.89% points) and impoverishment (4.8% points) of OPHE. Households in rural areas, in the middle and rich quintiles and those headed by a male were more likely to encounter financial catastrophe and impoverishment due to OPHE.Conclusion: Inter-provincial variation in financial hardships of OPHE provide aide to provincial level priority setting. The high impact of OPHE in the non-poor, in rural areas, and in KPK calls for enhanced targeting of financial risk protection plans

Role of social health insurance in improving financial access to health care : a qualitative appraisal of the situation in district Thatta Sindh, Pakistan

Title: Role of social health insurance (SHI) in improving financial access to health care: A qualitative appraisal of the situation in District Thatta, Sindh, Pakistan 1. What does Pakistan need to start SHI? 2. Can social health insurance improve financial access to health care for the rural vulnerable population, (women and children) of Thatta Health care cost is one of the major causes that forces people into catastrophic expenditure, people are forced to reduce expenditure on necessary items such as food, education of children and clothing. Pakistan has been suffering from low human development for decades. The vulnerable poor population has been dealing with the expensive, unresponsive health system for years now. The socioeconomic conditions of Pakistan, its agricultural economy and presence of poverty have made it important for the Government to reconsider its health care financing. The objectives of the study are • To analyze the literature to identify main challenges for social health insurance(SHI) in developing countries • To describe social health insurance experience from selected developing countries and social protection programmes in Pakistan • To identify the challenges for Pakistan to launch social health insurance(SHI) • To identify issues in the current financial assistance schemes for health in Thatta The study uses dual methodology for effective triangulation. The first two objectives are achieved by literature review, to develop a framework for social health insurance in developing countries by analyzing the literature and to describe experience from different countries. Since Pakistan does not have an experience with social health insurance experience, developing countries experience can been utilized to identify the challenges and to find ways to deal with these challenges. To achieve the later three objectives, the study utilizes qualitative exploratory approach. To achieve these objectives participants from government and NGOs were identified based on their involvement with social protection programmes for health. Participants from the community were identified based on their involvement in existing social protection run by Government or NGO in District Thatta. Purposive and convenience sampling strategy was used to recruit the study participants. In-depth interviews and focus group discussions (FGD), using the interview guidelines were used as data collection methods. In-depth interview were conducted with Government and Nongovernmental organizations (NGOs). Focus group discussions were conducted with the community participants. A total of 10 in-depth interviews, 5 from Government and 5 from NGO sector (one insurance company and one donor agency) were conducted. 6 FGD with 4 females groups and 2 male groups were conducted with the community. • To explore the perceptions of stakeholders on social health insurance(SHI) on improving financial access to healthcare The data analysis was done manually and with NVivo 2.0. The nodes, sub nodes and themes were identified based on the framework. The framework is based on the literature, based on challenges for SHI in developing countries. The qualitative data related to identifying the challenges for Pakistan to launch SHI is analyzed using this framework. Lack of political commitment and corruption were identified as the two major challenges by all stakeholders. Community showed a preference for pre-payment schemes, showed willingness to participate and pay for SHI. All stakeholders were of the opinion that SHI can improve people financial access to health care. The study concluded that SHI can be implemented in Pakistan in the long term. Epidemic of poverty and poor access to health care makes it important for Pakistan to consider an alternative financing mechanism and improve people\u27s access to health.SHI is one such mechanism which is fair and equitable

Preservation and Recovery of Metal-Tolerant Fungi from Industrial Soil and Their Application to Improve Germination and Growth of Wheat

Heavy metals contaminate soil and adversely affect plant growth. These soils contain different fungi and bacteria which exhibit metal tolerance and work as bioremediation agents to detoxify polluted soils. In the present study, polluted soil samples were collected to estimate the contamination of copper (Cu) and cadmium (Cd). From this contaminated soil, metal tolerant fungi were isolated and characterized. Copper and cadmium were found in a range of 190.2–300.4 mg/kg and 46.8–56.1 mg/kg, respectively. For the isolation of metal tolerant fungi, soil dilutions were made in water and inoculated on potato dextrose agar (PDA) media. Fungal growth was observed on PDA and successive screening resulted in the isolation of four multi-metal tolerant fungal species, including Penicillim oxalicum, Fusarium solani, Aspergillus niger and Trichoderma harzianum. Sequencing of 18S rRNA genes of isolated fungi also efficiently identified them. To reveal minimum inhibitory concentrations (MIC), these fungi were exposed to increasing concentrations of cadmium and copper chlorides (100 to 1000 ppm) and a variable MIC range of 400 ppm to 1000 ppm was estimated. Based on tolerance index analysis, F. solani was found to be resistant at 1 mM copper, while P. oxalicum was the most tolerant species under cadmium stress. F. solani and P. oxalicum demonstrated the highest biosorption capacity of Cu and Cd, respectively. Both metals negatively affected wheat seedlings in a pot experiment, while the treatment of both F. solani and P. oxalicum positively influenced the germination and growth of wheat. Based on these observations, it could be inferred that F. solani and P. oxalicum can be used for the myco-remediation of Cu and Cd, respectively

Preservation and Recovery of Metal-Tolerant Fungi from Industrial Soil and Their Application to Improve Germination and Growth of Wheat

Heavy metals contaminate soil and adversely affect plant growth. These soils contain different fungi and bacteria which exhibit metal tolerance and work as bioremediation agents to detoxify polluted soils. In the present study, polluted soil samples were collected to estimate the contamination of copper (Cu) and cadmium (Cd). From this contaminated soil, metal tolerant fungi were isolated and characterized. Copper and cadmium were found in a range of 190.2–300.4 mg/kg and 46.8–56.1 mg/kg, respectively. For the isolation of metal tolerant fungi, soil dilutions were made in water and inoculated on potato dextrose agar (PDA) media. Fungal growth was observed on PDA and successive screening resulted in the isolation of four multi-metal tolerant fungal species, including Penicillim oxalicum, Fusarium solani, Aspergillus niger and Trichoderma harzianum. Sequencing of 18S rRNA genes of isolated fungi also efficiently identified them. To reveal minimum inhibitory concentrations (MIC), these fungi were exposed to increasing concentrations of cadmium and copper chlorides (100 to 1000 ppm) and a variable MIC range of 400 ppm to 1000 ppm was estimated. Based on tolerance index analysis, F. solani was found to be resistant at 1 mM copper, while P. oxalicum was the most tolerant species under cadmium stress. F. solani and P. oxalicum demonstrated the highest biosorption capacity of Cu and Cd, respectively. Both metals negatively affected wheat seedlings in a pot experiment, while the treatment of both F. solani and P. oxalicum positively influenced the germination and growth of wheat. Based on these observations, it could be inferred that F. solani and P. oxalicum can be used for the myco-remediation of Cu and Cd, respectively