2.1 Data sources
The Uganda Demographic and Health Survey (UDHS) was a cross-sectional, nationally representative data conducted in 2016 by the Uganda Bureau of Statistics (UBOS) between June and December 2016 [9]. The UDHS project aimed to provide recent evidence on basic demographic and health indicators (key demographic indicators such as fertility, under-five, and adult mortality; contraceptive knowledge and practice; malaria prevalence; child feeding practices; a key aspect of child and maternal health; key education indicators; extend of gender-based violence and disability.[3] We used data based on the survey questionnaire (household), where demographic information and person characteristics were collected (age, sex, marital status, education, relationship with the household head). The UDHS also collected information on the money paid by households for health care services. In particular, the respondent provided information on the different ways they mobilised to finance health care access, out-of-pocket, community-based initiative/saving, health insurance through an employer, social security, and other privately purchased commercial health insurance. The survey was conducted on 19,588 households. Interviews were done face-to-face across the 15 regions of the country. Further information is available on the survey website.[4]
2.2. Variables
Regarding the dependent variable, the household’s health financial risk was measured by money paid to access health care services. Households’ heads were asked to answer the question: “Do you pay any money for the services offered?” Payment for health care includes (1) directly out-of-pocket; (2) community-based initiative/saving; (3) health insurance through employer; (4) social security; (5) other privately purchased commercial health insurance.[5]
The UDHS (2016) also included the DHS program disability section, a list of questions based on the Washington Group on Disability Statistics (WG) short Set referring to the International Classification of Functioning, Disability and Health (ICF) adopted by the World Health Organisation (WHO).[6] The disability was measured following the six different functional domains: seeing, hearing, communicating, remembering or concentrating, walking or climbing steps, and washing all over or dressing (self-care).[7] We recoded the disability variable as “1” if the respondent reported any of those and “0” elsewhere.
Then, we considered determinants such as marital status, residence (rural), region, the choice of the private sector for health care, education, wealth (index), age, gender, number of children under-five.
Further details regarding socio-economic and demographic characteristics are available on the Uganda DHS project. [8]
2.2 Methods
Descriptive statistics were used to provide more insight into the study sample. Then, we estimated the simple and multivariate “probit” models to investigate characteristics and factors associated with health financial risk. We estimated the following multivariate econometric equation:
Where, Financialriski represents the dependent variable to explain. Disabilityi is a binary variable and define as “Yes” if the household’s head reported any form of functional limitation and “No” elsewhere. Xi represents other explanatory variables. βi stands or the parameter to estimate. is the error term.
We used the STATA SE 64 statistical software 14.2 (StataCorp, LP, College Station, TX, USA) for statistical and econometric analysis.
Footnote:
[3] https://dhsprogram.com/pubs/pdf/FR333/FR333.pdf
[4] https://dhsprogram.com/data/dataset/Uganda_Standard-DHS_2016.cfm?flag=0
[5] It is important to note the number of family having access to health insurance through employer; social security; and other privately purchased commercial health insurance were quite low in Uganda.
[6]https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health/who-disability-assessment-schedule
[7] This approach provides basic essential information on disability comparable to those collected worldwide via Washington Group (WG) disability tools. Based on the household questionnaire, respondents were aged 15 or above.
[8] https://dhsprogram.com/data/dataset/Uganda_Standard-DHS_2016.cfm?flag=0