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The Cost of Health: A community research report

Training and Research Support Centre, Community Working Group on Health In the Community Monitoring Programme

July 2005

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Executive summary

It was resolved at the 2004 CWGH national meeting that the CWGH co-operate with Training and Research Support Centre (TARSC) through the Community Monitoring Programme (CMP) to outline and measure the costs of a ‘health basket’ similar to the Consumer Council of Zimbabwe (CCZ) food basket. This aims to make visible the costs of maintaining health for different Zimbabwean households. This would be accompanied by assessment of the ‘drivers’ of the rising costs of medical care for households reported in the CMP quarterly reports.

The programme thus obtained information from 20 districts in Zimbabwe the changing costs of hygiene, food, medical care and public health items for communities in urban, rural and peri urban areas. Information was collected from sources of health basket items in 20 districts and from 30 households per district in 11 new districts added since a round 1 survey in November 2004. Comparison is made from information gathered in November 2004 and June 2005 and from interview of households to assess the main elements that are drivers of cost increases in the ‘health basket’ , to identify items for which consumption has been stopped due to cost and to identify households most affected by these cost changes. The respondent profile in November 2004 and in June 2005 was largely similar enabling comparison across this two periods.

The programme also aims to build skills in research and survey methods and work, in managing data and in reporting and using findings amongst district level CWGH members. The reports are used to take up issues around these costs as CWGH in discussions with health authorities and officials at district and national level.

The nominal cost to the household for the health basket for one month found in this second round was Z$1 916 262 an increase of over 87% compared to the Z$1 023 386 found in the first round in October 2004.

According to the Central Statistical Office the Annual inflation rate as measured by the all items Consumer price index stood at 254.8 percent, this compared to 209.0 at the end of October 2004 showed a gain of about 48.8 percentage points on average. The 87% change in the health basket was well above the average gain in the annual inflation rate during the period October 2004 to July 2005. This implies that the costs of health is rising faster than the general CPI for all items.

Food items were found to be the major cost drivers of the health basket since November 2004. The top drivers of health costs were milk, eggs, meat, and shelter. Highest increases between November 2004 and June 2005 were found to be in costs of shelter, meat, anti-hypertensives, sugar, soap, milk, margarine and rape.

Products for which 30% or more of households had stopped consumption in the past month included
  • Hygiene products: bath soap, toilet rolls, cotton wool
  • Foods: Fresh milk, eggs, cooking oil, margarine, beans, peanut butter
  • Health care items: condoms.
A falloff in consumption of hygiene products exposes the poor households to water, feacal borne diseases. The fall off in high energy foods noted in this round would be most important for young children’s nutrition. A fall off in condom use can affect prevention of sexually transmitted diseases. These findings are similar to those found in the first round (for different households) where declining consumption was reported for high energy foods and such hygiene products.

Certain households were reported to be more likely to have stopped purchasing some items due to cost stress. The top four items where fallout from consumption had occurred at highest level were used as indicators. The households identified as vulnerable using this method were identified as households
  • Where the head of household is over 60 years old
  • Where the head of household has not completed grade 1
  • With unskilled heads of household, and
  • Where the head is unemployed.
The characteristics of households that were found to be vulnerable to cost pressures in this second round are not different from the findings of the first round of the health basket research.

The findings of this second round of the health basket research are not very different from those of the first round. Food, soap and shelter continue to dominate as the highest cost drivers compared to medical care. Poor households show signs of cost stress as the same items food, reproductive health and hygiene items are being dropped from the health basket without mention of substitutes. This raises the need to protect the most vulnerable groups through improved safety nets, economic and social security transfers, particularly to avoid overloading households and the public health sector.

This calls for strategies for protecting access to the basic food and hygiene items, particularly those that are being dropped due to economic stress that are vital for health, such as milk, beans, soap, tooth paste, condoms and oral contraceptives for women.

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