Abstract
BackgroundHome and community-based combined treatment of malaria and pneumonia has been promoted in Uganda since mid 2011. The combined treatment is justified given the considerable overlap between the symptoms of malaria and pneumonia among infants. There is limited evidence about the extent to which community-based care reduces healthcare-seeking costs at the household level in rural and urban settings. This paper assesses the rural–urban differences in direct and indirect costs of seeking care from formal health facilities compared to community medicine distributors (CMDs).MethodsExit interviews were conducted for 282 (159 rural and 123 urban) caregivers of children below five years who had received treatment for fever-related illnesses at selected health centres in Iganga and Mayuge districts. Data on the direct and indirect costs incurred while seeking care at the health centre visited were obtained. Using another tool, household level direct and indirect costs of seeking care from CMDs were collected from a total of 470 caregivers (304 rural and 166 urban). Costs incurred at health facilities were then compared with costs of seeking care from CMDs.ResultsHousehold direct costs of seeking care from health facilities were significantly higher for urban-based caregivers than the rural (median cost = US$0.42 for urban and zero for rural; p < 0.0001). The same is true for seeking care from CMDs (p = 0.0038). Overall, caregivers travelled for an average of 75 min to reach health centres and spent an average of 80 min at the health centre while receiving treatment. However, households in rural areas travelled for a significantly longer time (p < 0.001 to reach health care facilities than the urban-based caregivers. Besides travelling longer distances, rural caregivers spent 150 min seeking care from health facilities compared to 30 min from CMDs.ConclusionTime and monetary savings for seeking care from CMDs are significantly larger for rural than urban households. Thus, home and community-based treatment of child febrile illnesses is much more cost-saving for rural poor communities, who would spend more time travelling to health facilities - which time could be re-directed to productive and income-generating activities.
Highlights
Home and community-based combined treatment of malaria and pneumonia has been promoted in Uganda since mid 2011
Community-based health care interventions under the Integrated Community-based Case Management (ICCM) model are intended to provide prompt treatment so that illness does not progress to severe levels, reduce household costs of seeking treatment, and fill the gap that may exist due to inadequacy of health facilities, in remote areas [1]
The objective of this paper is to investigate differences in household-level costs incurred under the home and community-based treatment of malaria and pneumonia, as opposed to obtaining care at a formal health facility in both rural and urban areas
Summary
Home and community-based combined treatment of malaria and pneumonia has been promoted in Uganda since mid 2011. There is limited evidence about the extent to which this community-based intervention reduces household health care-seeking costs, and how cost of care at community level and health facility level compare between rural and urban settings. The objective of this paper is to investigate differences in household-level costs incurred under the home and community-based treatment of malaria and pneumonia, as opposed to obtaining care at a formal health facility in both rural and urban areas. This comparison is important to provide insights into whether community-based interventions are more relevant in rural settings with limited access to health care facilities than in urban areas
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