Research Article
Forgoing Healthcare Services: Evidence from a Household Survey in Abidjan (Côte d’Ivoire)
Issue:
Volume 11, Issue 2, June 2026
Pages:
49-59
Received:
18 January 2026
Accepted:
27 March 2026
Published:
28 April 2026
Abstract: Background: In Africa, healthcare is generally supported by households. The heavy burden of healthcare on household leaders can lead them to forego care. In this study, we analysed the determinants of healthcare renunciation among household leaders in Abidjan. Methods: This cross-sectional study was carried out from May to July 2019 in "colombie", a neighbourhood of Abidjan (Côte d’Ivoire). Heads of household that had been living there for at least 3 months were randomly selected. Sociodemographic, economic, health status and health care renunciation characteristics were collected. Logistic regression models were used. Results: The sample consisted of 648 heads of household with a mean age of 35.6 ± 8.37 years and a sex ratio (F/M) of 1.59. Almost all of them (97.53%) had given up care at least once. Medical consultations foregone concerned 57.56% of them (including 18.21% to the general practitioner and 39.35% to the specialist). After the consultation, 39.97% of them gave up on other care. People who reported poorer health (OR= 1.93 [1.14–3.29], p=0.015) and those who had no health coverage (OR=6.42 [3.90–11.00], p<0.001) gave up significantly more medical consultations. Heads of households with dependent children (OR=1.93 [1.15–3.34], p=0.015), those who were still in school (OR=1.89 [1.06–3.36, p=0.030]) and those without health insurance (OR=3.30 [1.80–6.19], p<0.001) were significantly more likely to forego postconsultation care. Conclusion: Literacy level, risk perception, health system responsiveness and health insurance coverage were drivers of healthcare renunciation. Health insurance coverage was the factor that most influenced renunciation at different stages of the care pathway. As a large number household leaders don’t benefit from health insurance, this work highlights the need to make health coverage functional in the country.
Abstract: Background: In Africa, healthcare is generally supported by households. The heavy burden of healthcare on household leaders can lead them to forego care. In this study, we analysed the determinants of healthcare renunciation among household leaders in Abidjan. Methods: This cross-sectional study was carried out from May to July 2019 in "colombie", ...
Show More
Review Article
A Scoping Review of Evidence-based Decision-making in Health Financing Reforms: Conceptual Frameworks and Experiences to Inform Health Policy in Cameroon
Issue:
Volume 11, Issue 2, June 2026
Pages:
60-83
Received:
15 April 2026
Accepted:
28 April 2026
Published:
14 May 2026
DOI:
10.11648/j.hep.20261102.12
Downloads:
Views:
Abstract: Evidence-informed decision-making is increasingly recognized as essential for health financing reforms. It can improve effectiveness, equity, and accountability while supporting progress towards Universal Health Coverage (UHC). However, its integration into decision-making to inform health policy processes remains uneven across different contexts. This review aims to synthesise the available knowledge on the use of evidence in health financing decision-making, including international experiences and lessons learned from Cameroon. A scoping review was conducted using the Arksey and O’Malley framework, later refined by Levac et al. Reporting followed the PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, and Web of Science, as well as in institutional sources such as WHO and the World Bank. Studies published between 2000 and 2025 in English or French were considered. Eligible studies included empirical and conceptual work on the use of evidence in health financing policies. Data were extracted using a standardized template and analysed thematically. A supplementary analysis of the case of Cameroon was carried out. Twenty-eight studies were included. The use of evidence appears to be multidimensional, encompassing quantitative, qualitative and economic data. Four main types of use were identified: instrumental, conceptual, strategic and interactive. High-income countries showed more institutionalized processes. In contrast, low- and middle-income countries faced fragmented practices, often influenced by external actors. The main determinants include governance structures, stakeholder interests, institutional capacities and the political context. Reforms were generally associated with improved access to care and financial protection, with varying effects on equity and quality. The use of evidence in health financing reforms is progressing but remains uneven. To accelerate progress towards Universal Health Coverage, policymakers should institutionalize evidence-informed decision-making. They should also strengthen national health information and financing data systems, invest in local analytical capacity, and promote transparent multi-stakeholder governance mechanisms. In low- and middle-income settings, reducing dependency on externally driven agendas and aligning reforms with national priorities will be critical to achieving equitable, efficient and sustainable health financing outcomes.
Abstract: Evidence-informed decision-making is increasingly recognized as essential for health financing reforms. It can improve effectiveness, equity, and accountability while supporting progress towards Universal Health Coverage (UHC). However, its integration into decision-making to inform health policy processes remains uneven across different contexts. ...
Show More
,
Akissi Regine Attia-Konan
