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dc.contributor.authorOnarheim, Kristine Husøy
dc.contributor.authorSisay, Mitike Molla
dc.contributor.authorGizaw, Muluken
dc.contributor.authorMoland, Karen Marie
dc.contributor.authorNorheim, Ole Frithjof
dc.contributor.authorMiljeteig, Ingrid
dc.date.accessioned2018-04-16T11:03:21Z
dc.date.available2018-04-16T11:03:21Z
dc.date.issued2018-03-02
dc.identifier.urihttp://hdl.handle.net/1956/17612
dc.description.abstract<p>Background: The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families&rsquo; opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities.</p> <p>Methods: A qualitative study was conducted in 2015 in Butajira, Ethiopia, comprising observation, semi-structured interviews, and focus group discussions with household members, health workers, and community members. Household members with hospitalized newborns or who had experienced neonatal death were primary informants.</p> <p>Results: In this predominantly rural and poor district, households struggled to pay out-of-pocket for services such as admission, diagnostics, drugs, and transportation. When newborns fell ill, families made hard choices balancing concerns for newborn health and other household needs. The ability to seek care, obtain services, and follow medical advice depended on the social and economic assets of the household. It was common to borrow money from friends and family, or even to sell a sheep or the harvest, if necessary. In managing household priorities and high costs, families waited before seeking health care, or used cheaper traditional medicines. For poor families with no money or opportunity to borrow, it became impossible to follow medical advice or even seek care in the first place. This had fatal health consequences for the sick newborns.</p> <p>Conclusions: While improving neonatal health is prioritized at policy level in Ethiopia, poor households with sick neonates may prioritize differently. With limited money at hand and high direct health care costs, families balanced conflicting concerns to newborn health and family welfare. We argue that families should not be left in situations where they have to choose between survival of the newborn and economic ruin. Protection against out-of-pocket spending is key as Ethiopia moves towards universal health coverage. A necessary step is to provide prioritized newborn health care services free of charge.</p>eng
dc.language.isoengeng
dc.publisherBioMed Centraleng
dc.relation.ispartof<a href="http://hdl.handle.net/1956/17619" target="_blank">Priority to the newborn? Real-life priority setting and intra-household resource allocation for newborn health in Ethiopia</a>
dc.rightsAttribution CC BYeng
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/eng
dc.subjectUniversal health coverageeng
dc.subjectCatastrophic health expenditureeng
dc.subjectPovertyeng
dc.subjectOut-of-pocket expenseseng
dc.subjectIntra-household decision makingeng
dc.subjectResource allocationeng
dc.subjectNewborn healtheng
dc.subjectHealth care seekingeng
dc.subjectEthiopiaeng
dc.titleSelling my sheep to pay for medicines – household priorities and coping strategies in a setting without universal health coverageeng
dc.typeJournal articleeng
dc.rights.holderCopyright 2018 The Author(s)eng
dc.type.versionpublishedVersioneng
bora.peerreviewedPeer reviewedeng
bora.journalTitleBMC Health Services Researcheng
bibo.volume18eng
bibo.number153eng
dc.identifier.doi10.1186/s12913-018-2943-yeng
dc.source.issn1472-6963eng
dcterms.isPartOfhttp://hdl.handle.net/1956/17619


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