Abstract of Masterʼs Dissertation
No.1

International Health
Development

CourseName

Takumi Sakamoto

Thesis

Effectiveness of Free Child Healthcare policy in reducing catastrophic healthTitle

expenditure: a facility-based prospective study in Kwale County, Kenya

Background: In the paradigm shift from Primary Health Care (PHC) to Universal Health

Coverage (UHC), financial protection has been widely recognized its importance.
Financial protection is often measured by incidence of catastrophic health expenditure(CHE). While indirect costs, such as transportation costs and income loss, are merely
considered health expenditures, those costs exacerbate financial hardship. Especially,childhood hospitalization inflates indirect costs since it usually involves accompanyingperson(s). In Kwale County, Kenya, although Free Child Healthcare Policy isimplemented, the Policy covers only direct costs. Thus, this study aims to assess theeffectiveness of the Policy in reducing CHE considering the costs that are not covered bythe Policy.
Objectives: The objective of this study is to assess the effectiveness of the Policy inreducing CHE by (i) comparing the difference in prevalence of CHE between factual (thecurrent situation under the Policy) and counterfactual (the situation as if the Policy had
not existed); (ii) exploring the determinants of CHE due to childhood hospitalization;and (iii) estimating the magnitude of indirect costs in health expenditure.
Methods: A facility-based prospective study was conducted in Kwale Sub-County

hospital, Kenya. Sample size was calculated in terms of prevalence of households
suffering CHE, considering non-response rates of 0.2 and withdrawal rate of 0.2 (n=72).
All inpatients under five years of age were targeted. Newborns without any disease wereexcluded from the target. The question about household expenditures and healthexpenditures were asked in structured interviews with their family. To calculate the direct
costs that were covered by the Policy, medical records were referred to. McNemarʼs test
was conducted to compare the difference in prevalence of CHE between factual andcounterfactual. To explore the factors associated with whether households undergo CHE,
logistic regression was conducted. Descriptive analyses were conducted to assess themagnitude of indirect costs in health expenditure.

iAbstract of Masterʼs Dissertation
No.2
CourseInternational HealthDevelopment

Name

Takumi Sakamoto

Results: A total of 59 households having child inpatients participated in this study. The

prevalence of CHE in counterfactual (72.9%) was significantly higher than that of CHE
in factual (50.9%) (P<0.001). The results of logistic regression showed that lower wealthquintile of households and longer duration of hospitalization were significantly associatedwith undergoing CHE. Overall, indirect costs accounted for 46.9% of total healthexpenditures. To accompany child inpatients, 55 households (93.2%) paid fortransportation, and 48 households (81.4%) paid for extra foods for accompanying person.
Moreover, 42 households (71.2%) underwent income loss because of a childʼshospitalization.
Conclusion: The Free Child Healthcare Policy was effective in reducing CHE due tochildhood hospitalization (22% = 72.9% - 50.9%). However, financial support covering
only direct costs is not enough to achieve UHC since indirect costs were large enough toincur CHE. Especially, indirect costs that are incurred by an accompanying person shouldbe paid attention to when child inpatients require healthcare services. Transportation
vouchers or an insurance system that covers income loss might be a feasible approach.
(478 words)

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