Economic Burden of Illness among the Self-Employed in the Commercial City of Port-Harcourt
Authors: E. Anderson Ikeokwu , O. Adeniji Foluke 
Published: December 2019

Introduction: The informal sector in Port-Harcourt harbours the small-scale and self-employed activities which are mainly for generating employment and incomes. Self-employed activities in Port-Harcourt is huge and well spread, which contributes over 50% of the state Gross Domestic Product. Even though the informal sector is an opportunity for generating reasonable incomes for many people, most informal workers are without secure income, employments benefits and social protection. For this they often face health related shocks, such as unpredictable illnesses that weaken their health status. This results into massive loss of income but also meagre resources that has been in a hard way saved over a long period of time. This study investigated the economic burden of illness among the self-employed in Port-Harcourt, Rivers State, in addition to the mechanisms that self-employed individuals used to pay for health services and cope with payments.

Methodology: This study was a cross-sectional descriptive in design which comprises of 204 self-employed individuals who were selected from seven different trade association in Port-Harcourt using asemi-structured interviewer-administered pre-tested questionnaire. A Socio-economic Status (SES) index was used to divide the households into quintiles, and ANOVA test was used to test for significant differences in the mean cost of illness by SES quintiles. Data collected were analysed using the statistical package for social science (SPSS), version 23 software.

Results: The results show that malaria was the illness most people had. The total cost of illness was ₦4602.93 ± 13194.072 ($12.7US) per month with Malaria contributing 102(50%) most recent self-reported cause of illness and most 145(71.0%) seeking treatment highlighted that their choice of healthcare provider are the patent medicine vendor popularly known as chemist. Total direct cost of illness accounted for 72.7% of the total cost of illness and 3.8% of income per month while the total indirect cost of illness accounted for 27.30% of the total cost of illness and 1.40% of income per month also the total cost of illness for respondents amounted to 6% of the poorest quintile monthly income, 1.8% for those in the poor quintile, 4.2% for those in the middle quintile, 6.2% for those in the rich quintile, while 7.5% for those in the richest quintile.

Conclusion: From the study findings, patent medicine vendor (chemist) was the most utilized in terms of choice of healthcare provider due to that the large cost of health care, in which this certain choice of healthcare provider (chemist) provides them with alternatives such as avoiding consultation fees and flexibility of payment, but most of this chemist lack training in the holistic approach towards healthcare and delivery, with their sole aim of maximizing profit rather than improving health outcomes, thereby endangering their clients by predisposing them to catastrophic health expenditure, because of frequent visit due to unrecovered health problems. To improve health outcomes and decrease the level of poverty due to catastrophic health expenditure, the nation health system should incorporate this certain group of health provider into the health system where they could be trained in topics such as; first aid care, referral system also strict policies on regulating their operation needs to be regulated and monitored adequately. Also, to attain universal health coverage with quality health services, introduction of cost sharing schemes is of dire need among the informal sector. These schemes create affordable healthcare at the time of sickness, thereby reducing the incidence of out-of-pocket payment which act as the main barrier in accessing healthcare.