Skip to content
DraconiticResearch
Search Sources API
203,234 studies31 sourcesUpdated 59 min ago
Peer-reviewedCC BY 4.0Frontiers in Neurology

Out-of-pocket expenditure for neurosurgical care in Uganda: quantifying financial catastrophe and identifying policy pathways to universal health coverage

  • Allan Bakesiga1,2,3
  • Claudia Fernandez Perez2,4
  • Tonny Kyagambiddwa2,5
  • Patrick Agaba1,6
  • Eric Ochen7,8
  • Joseph Mary Ssembatya7,8
  • Imran Mukiibi1
  • Beatrice Katusiime7,8
  • Angela Sapu2,3
  • Abdul Karim Katende9
  • Nadine Fanous2,3
  • Douglass Seruwu1
10 more authors
  • Benjamin Mukumbya2
  • Christine Muhumuza2,10
  • Josephine Najjuma7,8
  • Blessing M. Taremwa7,8
  • Juliet Nalwanga1,6
  • Osondu Ogbuoji3
  • Joel A. Kiryabwire1,6
  • David Kitya7,8
  • Michael M. Haglund2,3,11,12
  • Alvan-Emeka K. Ukachukwu2,3,11,12
12 affiliations
  1. 1Department of Neurosurgery, Mulago National Referral Hospital
  2. 2Duke Global Neurosurgery and Neurology
  3. 3Duke Global Health Institute
  4. 4Georgetown University School of Medicine
  5. 5Our Lady of Consolata Kisubi Hospital
  6. 6Division of Neurosurgery, Department of Surgery, Makerere University
  7. 7Division of Neurosurgery, Mbarara University of Science and Technology
  8. 8Division of Neurosurgery, Mbarara Regional Referral Hospital
  9. 9St. Francis Hospital
  10. 10Makerere University School of Public Health
  11. 11Duke University School of Medicine
  12. 12Department of Neurosurgery, Duke University Health System
Open at sourceDOICite

Abstract

Background: Out-of-pocket payments remain the primary source of healthcare financing in many low- and middle-income countries, frequently resulting in catastrophic and impoverishing expenditures. Neurosurgical care is particularly costly due to substantial direct and indirect expenses borne by patients and caregivers, typically with little or no financial protection. This study quantifies these OOP costs, estimates the prevalence of catastrophic and impoverishing health expenditures, and examines their socioeconomic impact to inform equitable surgical financing policies.

Methods: We conducted a cross-sectional study at the two main Ugandan public neurosurgical centers - Mulago National Referral Hospital, Kampala, and Mbarara Regional Referral Hospital, Mbarara. Consecutive patients with confirmed neurosurgical diagnoses were enrolled at discharge or within two weeks post-discharge. Structured surveys captured sociodemographic, clinical and cost data. OOP health payments were direct medical plus direct non-medical payments; total economic burden added indirect costs. Catastrophic health expenditure (CHE) was OOP payments exceeding 10% of annual household consumption expenditure (World Bank) or 40% of it after food costs (WHO). Impoverishment was the change in poverty headcount against the $3.00/person/day line (2021 purchasing power parity). Data was analyzed using R 4.4.2. Ethical approval was obtained from Ugandan and Duke University institutional review boards.

Results: Seventy-six respondents (mean age 39 years; 65% male) were enrolled, mostly at discharge (67%). Traumatic brain injury was the leading diagnosis (65.8%). No participant had health insurance. Median OOP health payments were UGX1.23 million [$351] (direct medical UGX880,000 [$251]; direct non-medical UGX359,000 [$103]); adding indirect costs of UGX125,000 [$36] gave a median total economic burden of UGX1.38 million [$394]. OOP payments exceeded 10% of annual household expenditure in 76.0% of households (95% CI 65.2 to 84.2) and 40% of capacity to pay in 41.2% (30.3 to 53.0). The poverty headcount rose from 50.7 to 62.7% (net impoverishment 12.0%).

Conclusion: Neurosurgical care in Uganda imposes a substantial economic burden on households: three quarters incurred catastrophic expenditure, and one in eight of those not already poor was pushed below the poverty line. These findings highlight the urgent need for financial risk protection, targeted subsidies, and health system reforms to ensure equitable and sustainable access to neurosurgical services.

Related

  1. Digital financial literacy and household consumption: Total expenditure versus consumption structure in China
    Yan Shen, Wenxiu Hu, Xin Wang
    PLOS OnePeer-reviewedCC BY 4.0NeuroscienceStatisticsPLOS
  2. The financial burden of climate disasters on household's health expenditure: evidence from Australia
    Alejandro Betancourt-Odio, Marlene Fonseca, Santiago Budría
    Frontiers in Public HealthPeer-reviewedCC BY 4.0Epidemiology & public healthFrontiersCrossref
  3. Comparison of DeepSeek AI and Human Reviewers in Structured Evaluation of Neurosurgical Manuscripts: A Pilot Study
    Daniel A. Donoho
    Journal of Neurological Surgery ReportsPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  4. Neurosurgical Outcomes of Epilepsy Surgery Between 2017 and 2025: A Retrospective ESSQ-19 Study From a Tertiary Care Center
    Kiran Kumari, Govind Mangal, Gaurav Gupta +1
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  5. A Semi-Automated Interactive Annotation Framework for Intraoperative Neurosurgical Ultrasound: A Proof-of-Concept Study
    R. Bertani, S. Bahadir, M. Y. Ferreira +3
    medRxivPreprintAll rights reservedFull textMedical imaging & radiologymedRxiv

Cite

BibTeXRIS
BibTeX
@article{bakesiga2026outofpocket,
  title = {{Out-of-pocket expenditure for neurosurgical care in Uganda: quantifying financial catastrophe and identifying policy pathways to universal health coverage}},
  author = {Allan Bakesiga and Claudia Fernandez Perez and Tonny Kyagambiddwa and Patrick Agaba and Eric Ochen and Joseph Mary Ssembatya and Imran Mukiibi and Beatrice Katusiime and Angela Sapu and Abdul Karim Katende and Nadine Fanous and Douglass Seruwu and Benjamin Mukumbya and Christine Muhumuza and Josephine Najjuma and Blessing M. Taremwa and Juliet Nalwanga and Osondu Ogbuoji and Joel A. Kiryabwire and David Kitya and Michael M. Haglund and Alvan-Emeka K. Ukachukwu},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = nov,
  doi = {10.3389/fneur.2026.1897555},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1897555/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Out-of-pocket expenditure for neurosurgical care in Uganda: quantifying financial catastrophe and identifying policy pathways to universal health coverage
AU  - Allan Bakesiga
AU  - Claudia Fernandez Perez
AU  - Tonny Kyagambiddwa
AU  - Patrick Agaba
AU  - Eric Ochen
AU  - Joseph Mary Ssembatya
AU  - Imran Mukiibi
AU  - Beatrice Katusiime
AU  - Angela Sapu
AU  - Abdul Karim Katende
AU  - Nadine Fanous
AU  - Douglass Seruwu
AU  - Benjamin Mukumbya
AU  - Christine Muhumuza
AU  - Josephine Najjuma
AU  - Blessing M. Taremwa
AU  - Juliet Nalwanga
AU  - Osondu Ogbuoji
AU  - Joel A. Kiryabwire
AU  - David Kitya
AU  - Michael M. Haglund
AU  - Alvan-Emeka K. Ukachukwu
PY  - 2026
DA  - 2026/11/04
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1897555
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1897555/full
AB  - Background: Out-of-pocket payments remain the primary source of healthcare financing in many low- and middle-income countries, frequently resulting in catastrophic and impoverishing expenditures. Neurosurgical care is particularly costly due to substantial direct and indirect expenses borne by patients and caregivers, typically with little or no financial protection. This study quantifies these OOP costs, estimates the prevalence of catastrophic and impoverishing health expenditures, and examines their socioeconomic impact to inform equitable surgical financing policies.  Methods: We conducted a cross-sectional study at the two main Ugandan public neurosurgical centers - Mulago National Referral Hospital, Kampala, and Mbarara Regional Referral Hospital, Mbarara. Consecutive patients with confirmed neurosurgical diagnoses were enrolled at discharge or within two weeks post-discharge. Structured surveys captured sociodemographic, clinical and cost data. OOP health payments were direct medical plus direct non-medical payments; total economic burden added indirect costs. Catastrophic health expenditure (CHE) was OOP payments exceeding 10% of annual household consumption expenditure (World Bank) or 40% of it after food costs (WHO). Impoverishment was the change in poverty headcount against the $3.00/person/day line (2021 purchasing power parity). Data was analyzed using R 4.4.2. Ethical approval was obtained from Ugandan and Duke University institutional review boards.  Results: Seventy-six respondents (mean age 39 years; 65% male) were enrolled, mostly at discharge (67%). Traumatic brain injury was the leading diagnosis (65.8%). No participant had health insurance. Median OOP health payments were UGX1.23 million [$351] (direct medical UGX880,000 [$251]; direct non-medical UGX359,000 [$103]); adding indirect costs of UGX125,000 [$36] gave a median total economic burden of UGX1.38 million [$394]. OOP payments exceeded 10% of annual household expenditure in 76.0% of households (95% CI 65.2 to 84.2) and 40% of capacity to pay in 41.2% (30.3 to 53.0). The poverty headcount rose from 50.7 to 62.7% (net impoverishment 12.0%).  Conclusion: Neurosurgical care in Uganda imposes a substantial economic burden on households: three quarters incurred catastrophic expenditure, and one in eight of those not already poor was pushed below the poverty line. These findings highlight the urgent need for financial risk protection, targeted subsidies, and health system reforms to ensure equitable and sustainable access to neurosurgical services.
SN  - 1664-2295
ER  -