Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9-20.4; 50 datapoints; 462 151 households; P= 99.9%) fora threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2-10.3; 84 datapoi nts; 795 355 households; P= 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed.

Automated summary

This study aimed to estimate the incidence and trends of catastrophic health expenditure in sub-Saharan Africa. The results showed that a significant proportion of households in sub-Saharan Africa experienced catastrophic expenditure when accessing healthcare services, with countries in central and southern regions having the highest and lowest incidence rates, respectively. The incidence of catastrophic health expenditure increased between 2010 and 2020, and individuals with specific diseases had a higher risk. The study highlights the need for stronger financial protection measures.