Dynamics of Healthcare Financing in Global Surgery: A Significant Barrier to Care in Africa - A Quantitative Analytical Study

BACKGROUND: Nearly 81 million people who pay for surgery out-of-pocket may incur catastrophic expenditures, which is defined as spending >10% of household income on surgical care. This study aimed to understand the funding structures, cost models, and their impact on access to cleft surgical care in Africa. METHODS: This was a cross-sectional study of 1966 participants who received surgery through Operation Smile between 2020 and 2023 in Africa. Health insurance status and monthly household expenditures (HHE), which is used as a proxy for household income, were collected. The cost of cleft care in-country was obtained from local experts. RESULTS: The median cost of cleft surgical care was $671 (95% CI: $142– $2485). In Morocco and Ghana, the average cost of cleft care was $1,627 and $633, respectively, accounting for less than 10% of HHE. In contrast, in South Africa, Rwanda, Ethiopia, Madagascar, and Egypt, the average cost of cleft care was $4,470, $671, $130, $438, and $954, respectively, which accounts for more than 10% of HHE. CONCLUSION: In many African nations, the cost of cleft surgical care can far exceed household expenditure capacity, making it difficult to obtain care. Future steps include advocacy for national health insurance that cover cleft care as well as promoting cost sharing models and subsidies that can reduce the financial burden.