Scaling up antiretroviral treatment () through decentralization of care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether care decentralization has a protective effect against the risk of CHE associated with HIV infection.
We use primary data from the cross‐sectional 12‐116 survey, conducted in 2006–2007 among a random sample of 3,151 ‐infected outpatients followed up in 27 hospitals in ameroon.
Data Source and Study Design
Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply‐related characteristics. We assess the determinants of among the ‐treated patients using a hierarchical logistic model ( = 2,412), designed to adequately investigate the separate effects of patients and supply‐related characteristics.
Expenditures for care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of .
The findings suggest that HIV care decentralization is likely to enhance equity in access to . Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of , unless other innovative reforms in health financing are introduced.
Data Collection and Methods