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Keywords

Catastrophic health expenditure (CHE); out-of-pocket payments; surgical care; financial protection; Nigeria; health systems; access to care

Background

Out-of-pocket (OOP) payments remain the dominant mechanism for healthcare financing in Nigeria and pose a significant barrier to accessing care. Limited risk pooling and inadequate financial protection mechanisms place many households at risk of catastrophic health expenditure (CHE), particularly when seeking life-saving interventions such as surgery. CHE refers to healthcare spending that results in financial hardship for households.

Beyond immediate financial strain, CHE can destabilize families, often forcing them to adopt coping strategies such as borrowing money, selling assets, or delaying care. While these consequences are recognized, the specific coping mechanisms and their broader implications remain insufficiently characterized in the Nigerian surgical context.

Objectives

• To determine the proportion of patients experiencing catastrophic health expenditure (CHE) among those receiving surgical care at district-level hospitals in the Federal Capital Territory (FCT), Nigeria
• To identify sociodemographic and clinical determinants associated with CHE
• To explore and characterize the coping strategies households employ in response to high OOP surgical costs

Methods Overview

This study employs a cross-sectional mixed-methods design conducted over a four-month period, with recruitment occurring as patients present for surgery.

• Quantitative component: Structured surveys and medical chart reviews to assess costs, income, and CHE thresholds
• Qualitative component: Semi-structured patient interviews to explore lived experiences and coping mechanisms

This approach allows for both measurement of CHE burden and deeper understanding of its real-world consequences on households.

Lessons Learned (Preliminary Insights)

• High reliance on OOP payments contributes significantly to financial hardship among surgical patients
• Coping strategies such as borrowing, asset liquidation, and delayed care are common and may worsen health outcomes
• Financial barriers can alter care-seeking behavior, sometimes converting elective conditions into emergencies
• There is a critical gap in financial protection mechanisms for surgical care at the district level

Summary / Conclusion

Catastrophic health expenditure is prevalent among patients undergoing surgery in district-level hospitals in Abuja and has profound effects on both financial stability and health outcomes. The burden of OOP costs not only limits access to timely care but can also exacerbate disease severity by delaying treatment. These findings highlight the urgent need for strengthened financial protection policies and expanded risk-pooling mechanisms to improve equitable access to surgical care in Nigeria.