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The
cost of health: A community research report
Training and Research Support Centre (TARSC), Community Working
Group on Health (CWGH)
July 2005
http://www.tarsc.org/publications/documents/Cost
of health Rep FINAL.pdf
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Executive
summary
It
was resolved at the 2004 CWGH national meeting that the CWGH co-operate
with Training and Research Support Centre (TARSC) through the Community
Monitoring Programme (CMP) to outline and measure the costs of a
‘health basket’ similar to the Consumer Council of Zimbabwe (CCZ)
food basket. This aims to make visible the costs of maintaining
health for different Zimbabwean households. This would be accompanied
by assessment of the ‘drivers’ of the rising costs of medical care
for households reported in the CMP quarterly reports.
The programme
thus obtained information from 20 districts in Zimbabwe the changing
costs of hygiene, food, medical care and public health items for
communities in urban, rural and peri urban areas. Information was
collected from sources of health basket items in 20 districts and
from 30 households per district in 11 new districts added since
a round 1 survey in November 2004. Comparison is made from information
gathered in November 2004 and June 2005 and from interview of households
to assess the main elements that are drivers of cost increases in
the ‘health basket’ , to identify items for which consumption has
been stopped due to cost and to identify households most affected
by these cost changes. The respondent profile in November 2004 and
in June 2005 was largely similar enabling comparison across this
two periods.
The programme
also aims to build skills in research and survey methods and work,
in managing data and in reporting and using findings amongst district
level CWGH members. The reports are used to take up issues around
these costs
as CWGH in discussions with health authorities and officials at
district and national level.
The nominal
cost to the household for the health basket for one month found
in this second round was Z$1 916 262 an increase of over 87% compared
to the Z$1 023 386 found in the first round in October 2004.
According to
the Central Statistical Office the Annual inflation rate as measured
by the all items Consumer price index stood at 254.8 percent, this
compared to 209.0
at the end of October 2004 showed a gain of about 48.8 percentage
points on average. The 87% change in the health basket was well
above the average gain in the annual inflation rate during the period
October 2004 to July 2005.
This implies that the costs of health is rising faster than the
general CPI for all items
Food items were
found to be the major cost drivers of the health basket since November
2004. The top drivers of health costs were milk, eggs, meat, and
shelter.
Highest increases between November 2004 and June 2005 were found
to be in costs of shelter, meat, anti-hypertensives, sugar, soap,
milk, margarine and rape.
Products for
which 30% or more of households had stopped consumption in the past
month included:
- Hygiene products:
bath soap, toilet rolls, cotton wool
- Foods: Fresh
milk, eggs, cooking oil, margarine, beans, peanut butter
- Health care
items: condoms.
A falloff in
consumption of hygiene products exposes the poor households to water,
feacal borne diseases. The fall off in high energy foods noted in
this round would be most important for young children’s nutrition.
A fall off in condom use can affect prevention of sexually transmitted
diseases. These findings are similar to those found in the first
round (for different households) where declining consumption was
reported for high energy foods and such hygiene products.
Certain households
were reported to be more likely to have stopped purchasing some
items due to cost stress. The top four items where fallout from
consumption had occurred at highest level were used as indicators.
The households identified as vulnerable using this method were identified
as households
- Where the
head of household is over 60 years old
- Where the
head of household has not completed grade 1
- With unskilled
heads of household, and
- Where the
head is unemployed.
The characteristics
of households that were found to be vulnerable to cost pressures
in this second round are not different from the findings of the
first round of the health basket research.
The findings
of this second round of the health basket research are not very
different from those of the first round. Food, soap and shelter
continue to dominate as the highest cost drivers compared to medical
care. Poor households show signs of cost stress as the same items
food, reproductive health and hygiene items are being dropped from
the health basket without mention of substitutes. This raises the
need to protect the most vulnerable groups through improved safety
nets, economic and social security transfers, particularly to avoid
overloading households and the public health sector.
This calls for
strategies for protecting access to the basic food and hygiene items,
particularly those that are being dropped due to economic stress
that are vital for health, such as milk, beans, soap, tooth paste,
condoms and oral contraceptives for women.
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full document
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and Research Support Centre (TARSC) fact
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sheet
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