Assessment of Household Strategies to Cope with Costs of Illness in Rural Communities, Jimma Zone

Health calamities are one of the conU1lOn causes of impoverishment at the household level; and different households find different mechanisms for adapting to the same calamitous circumstance. Nowadays, in many developing countries, affordability of health care is a growing concern both for policy makers and households, as people are expected to contribute more from their own pockets in getting health care due to health sector financing reforms and privatization. This cross-sectional study, which has used both quantitative and qualitative methods of data collection, was conducted from February to October 2000 in 630 randomly selected ruml households living in a predominantly coffee growing district of southwest Etlliopia. The main objective of the study was to assess the strategies used by households to cope with the financial and time costs of illness. The average cost of visiting a health care provider for one illness episode was found to be 32.87 Birr (about 4 US$), of which expenditures for drugs, transpOlt and lodging away from home while seeking health care were considerable. In an attempt to quantify the economic implications of morbidity at the household level, days lost due to illness were determined. Accordingly, adults who have repOlted illness in the one-month recall period have lost 9.23 working days, which corresponds to a loss of about 138.45 Birr (about 17 US$) in one month . About 42% of the studied households with sick family members in the recall period of sixmonths were found not purchase outside health care for reasons associated with out of pocket 11 expenditure of health care costs. Main mechani sms use to cope with the financial costs of illnesses were looking for exemption paper (16.8%), sale of household assets (13.3%), use of household saving (\3.1 %), and going into debt ( 12.7%). In addition, about 64% of tJle housebolds did nothing to cope the potential time lost due to illness. Using multiple logistic regressIOn, socio-demographic and economic factors at the household le ve l, which have significant association with the choice of mechanisms for coping, were identifi ed. Based on the results of the study, altemative strategies of financing the local health services incorporating indigenous social networks like "eder" were di scussed and reconullendations forwarded

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