Journal Article

“Poverty is the big thing”: exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda

Nwala, Emmanuel, Keya, Kaji Tamanna, Sripad, Pooja, Warren, Charlotte E.

2018

Overview

Background Women living with obstetric fistula often live in poverty and in remote areas far from hospitals offering surgical repair. These women and their families face a range of costs while accessing fistula repair, some of which include: management of their condition, lost productivity and time, and transport to facilities. This study explores, through women’s, communities’, and providers’ perspectives, the financial, transport, and opportunity cost barriers and enabling factors for seeking repair services. Methods A qualitative approach was applied in Kano and Ebonyi in Nigeria and Hoima and Masaka in Uganda. Between June and December 2015, the study team conducted in-depth interviews (IDIs) with women affected by fistula ( n  = 52) – including those awaiting repair, living with fistula, and after repair, and their spouses and other family members ( n  = 17), along with health service providers involved in fistula repair and counseling ( n  = 38). Focus group discussions (FGDs) with male and female community stakeholders ( n  = 8) and post-repair clients ( n  = 6) were also conducted. Results Women’s experiences indicate the obstetric fistula results in a combined set of costs associated with delivery, repair, transportation, lost income, and companion expenses that are often limiting. Medical and non-medical ancillary costs such as food, medications, and water are not borne evenly among all fistula care centers or camps due to funding shortages. In Uganda, experienced transport costs indicate that women spend Ugandan Shilling (UGX) 10,000 to 90,000 (US$3.00-US$25.00) for two people for a single trip to a camp (client and her caregiver), while Nigerian women (Kano) spent Naira 250 to 2000 (US$0.80-US$6.41) for transportation. Factors that influence women’s and families’ ability to cover costs of fistula care access include education and vocational skills, community savings mechanisms, available resources in repair centers, client counseling, and subsidized care and transportation. Conclusions The concentration of women in poverty and the perceived and actual out of pocket costs associated with fistula repair speak to an inability to prioritize accessing fistula treatment over household expenditures. Findings recommend innovative approaches to financial assistance, transport, information of the available repair centers, rehabilitation, and reintegration in overcoming cost barriers.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Barriers / Care and treatment / Childbirth & labor / Communities / Costs / Demographic aspects / Diagnosis / Economic aspects / Employment / Equality and Human Rights / Expenditures / Female / Financial cost / Fistula / Fistula - surgery / Fistulae / Fistulas / Focus Groups / Genital Diseases, Female - surgery / Gynecology / Health aspects / Health Expenditures / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Accessibility - economics / Health Services Accessibility - organization & administration / Health Services Research / Hospitals / Humans / Income / Influence / Low income groups / Malaria / Medicine / Medicine & Public Health / Middle Aged / Nigeria / Obstetrics / Opportunity cost / Opportunity costs / Patient Acceptance of Health Care - psychology / Poor women / Poverty / Prevention / Public Health / Rehabilitation / Shortages / Social aspects / Social Justice / Social Policy / Time Factors / Transportation / Transportation cost / Transportation costs / Uganda / Womens health