The contribution of pediatric surgery to poverty trajectories in Somaliland.

Emily R Smith,Mubarak Mohamed,Edna Adan Ismail,Shugri Dahir,Anirudh Krishna,Henry E Rice,Tessa L Concepcion,Shihe Fu

doi:10.1371/journal.pone.0219974

Abstract

BackgroundThe provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland.MethodsThis work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework.ResultsWe found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty.ConclusionOur study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment.

Highlights

The provision of health care in low-income and middle-income countries (LMICs) is increasingly recognized as a significant contributor to economic growth
Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status
The failure to provide surgical care has been estimated to lead to reduction in gross domestic product (GDP) by as much as 2% in many LMICs by 2030.[1]. Most existing microeconomic studies have measured the financial burden of medical costs on impoverishment, with up to 81 million people estimated to be at risk of falling into poverty due to catastrophic expenditures related to direct costs of surgical care as well as indirect costs of required lodging, transportation, and food.[1]

Summary

Introduction

The provision of health care in low-income and middle-income countries (LMICs) is increasingly recognized as a significant contributor to economic growth. The provision of surgical care in LMICs affects national economies on a macroeconomic level, and impacts individual families and communities at a microeconomic level. The failure to provide surgical care has been estimated to lead to reduction in gross domestic product (GDP) by as much as 2% in many LMICs by 2030.[1] Most existing microeconomic studies have measured the financial burden of medical costs on impoverishment, with up to 81 million people estimated to be at risk of falling into poverty due to catastrophic expenditures related to direct costs of surgical care as well as indirect costs of required lodging, transportation, and food.[1] these studies do not measure how the presence of a surgical condition itself impacts the risks of poverty, regardless of health care expenditures. The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and impacts individual families at a microeconomic level.

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Discussion

Conclusion