Research Article
Direct Cost Analysis of Diagnostic Digestive Endoscopy Based on Indications and Results in Yaoundé: Policy Implications for Universal Health Coverage in Cameroon
Issue:
Volume 10, Issue 3, September 2025
Pages:
77-89
Received:
16 June 2025
Accepted:
30 June 2025
Published:
19 July 2025
Abstract: In low-income countries, the cost of digestive endoscopy procedures is often unknown, yet its understanding is crucial for including them in the universal health coverage benefit package. The management of digestive endoscopy requires substantial financial contribution from patients, especially in Cameroon where more than 70% of health expenditures are incurred by households. This study assessed the direct costs of diagnostic digestive endoscopy, based on indications and patient outcomes in Yaoundé, Cameroon. A retrospective cross-sectional study was conducted, over a period of twelve months in the digestive endoscopy units of two referral health facilities (one private and one public). The sampling exhaustively included the reports of gastroscopies and diagnostic colonoscopies. Direct costs were estimated from expenditures for examination, anaesthesia, biopsy, colonic preparation in the patient's perspective in relation to clinical indications, endoscopies (type of anaesthesia, type of endoscopy, biopsy, results) of gastroscopies and colonoscopies performed. The average total cost was estimated by dividing the overall total cost by the number of patients. The costs were expressed in Central Africa Francs XAF, and US Dollars ($1= 554.24 XAF). Statistical analyses used the non-parametric Mann-Whitney test. Differences at the 5% threshold were considered significant. A total of 1,147 reports met our selection criteria: 754 gastroscopies and 393 diagnostic colonoscopies with an average patient age of 45 years. In gastroscopy, 46.8% were men and 53.2% were women, while in colonoscopy, there were 58.3% men and 41.7% women. The average direct cost of gastroscopy was estimated at 46,981 XAF ($84.77) per patient; while the cost of colonoscopy was 117,692 XAF ($212.35) per patient. The main indications that influenced the overall direct cost of gastroscopy were: pyrosis with 42,000 XAF ($75.7) and melena with 45,000 XAF ($81). The endoscopic findings responsible for a fluctuation in this cost were mainly: bulbar ulcer and absence of lesions, each with 60,000 XAF ($108.11). The overall direct cost of colonoscopy was influenced by indications such as: rectorrragies with 109,000 XAF ($196.4) and abdominal pain with 108,200 XAF ($194.96); as well as by certain results such as: absence of lesions with 108,000 XAF ($194.59) and colonic polyps with 142,000 XAF ($255.86). The study concludes that digestive endoscopy was likely expensive in the study setting. Often some inappropriate indications were posed, such as pyrosis and abdominal pain, thereby contributing to increase the cost of digestive endoscopy. This makes digestive endoscopy financially inaccessible to less well-off patients. The policy implications lies in providing evidence for subsidising the costs of digestive endoscopy as part of universal health coverage benefit package in Cameroon.
Abstract: In low-income countries, the cost of digestive endoscopy procedures is often unknown, yet its understanding is crucial for including them in the universal health coverage benefit package. The management of digestive endoscopy requires substantial financial contribution from patients, especially in Cameroon where more than 70% of health expenditures...
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Research Article
The Financing of Public Hospitals in Senegal: Taking into Account the Anti-selection
Issue:
Volume 10, Issue 3, September 2025
Pages:
90-99
Received:
28 May 2025
Accepted:
23 June 2025
Published:
28 July 2025
DOI:
10.11648/j.hep.20251003.12
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Abstract: The objective of our study was to analyze the anti-selection that exists between the state and public hospitals in Senegal. The use of a theoretical model to highlight hospital regulation has led to a number of important results. Indeed, the optimal solution consists in introducing a distortion in the cost reduction effort required to achieve an arbitrage between productive efficiency and the extraction of the hospital’s rent. The use of a menu of non-linear contracts for hospital funding is consistent with a cost reimbursement policy (such as the overall envelope policy) while a menu of linear contracts is modelled on the fixed-price pricing system (for example, by pathology or activity).
Abstract: The objective of our study was to analyze the anti-selection that exists between the state and public hospitals in Senegal. The use of a theoretical model to highlight hospital regulation has led to a number of important results. Indeed, the optimal solution consists in introducing a distortion in the cost reduction effort required to achieve an ar...
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Research Article
Analysis of the Political Economy and Financing of Family Planning in Togo: Challenges, Opportunities, and Prospects
Issue:
Volume 10, Issue 3, September 2025
Pages:
100-117
Received:
2 July 2025
Accepted:
14 July 2025
Published:
30 July 2025
DOI:
10.11648/j.hep.20251003.13
Downloads:
Views:
Abstract: Background: Sexual and reproductive health (SRH), including family planning (FP), is crucial for human development and the reduction of maternal and infant mortality. In Togo, although progress has been made in accessing SRH services, significant disparities persist, particularly in rural areas and among youth. The funding for FP largely relies on international partners, which jeopardizes the sustainability of interventions. Methods: The study employed a methodological approach combining a literature review and interviews with key stakeholders involved in the budgeting process. The analysis examined political commitments, available funding sources, and public expenditures specifically allocated to FP, while identifying major constraints and opportunities for resource mobilization. Results: The findings indicate that over 80% of FP funding comes from external partners. Togo has made political commitments regarding FP, but budget execution and domestic resources remain inadequate. Unmet needs for contraception affect 24.1% of women of reproductive age, and challenges persist in accessing services, particularly for youth and in rural areas. Conclusions: Despite notable advancements, FP funding in Togo remains heavily dependent on external financing, posing risks to the sustainability of programs. It is crucial to increase national investments, improve coordination among stakeholders, and diversify funding sources to ensure equitable and sustainable access to reproductive health services.
Abstract: Background: Sexual and reproductive health (SRH), including family planning (FP), is crucial for human development and the reduction of maternal and infant mortality. In Togo, although progress has been made in accessing SRH services, significant disparities persist, particularly in rural areas and among youth. The funding for FP largely relies on ...
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,
Agnès Ingrid Kpolom Ebéké,
Antonin Wilson Ndjitoyap Ndam
