The DHS Program User Forum
Discussions regarding The DHS Program data and results
Home » DHS-8 Questionnaire Review - Archived » Other Topics » DHS-8-PGSSC-Total_Household_Expenditure-Template
DHS-8-PGSSC-Total_Household_Expenditure-Template [message #16801] Tue, 05 March 2019 17:28 Go to next message
PGSSC is currently offline  PGSSC
Messages: 10
Registered: March 2019
Location: Boston, USA
Member
The questions we propose are a product of the Lancet Commission on Global Surgery (LCoGS), a body of work spanning three years involving 25 commissioners and a diverse group of academic, governmental and civil society collaborators from 110 countries. Of the six indicators proposed by the LCoGS, four were published in the World Development Indicators by the World Bank and all six are included in the World Health Organization's Global Reference List of 100 Core Health Indicators. Nevertheless, there currently are no mechanisms in place to collect the data required for these indicators, creating a critical gap in knowledge for surgical care strengthening.

The new indicators in this proposal span four existing DHS modules. For clarity, they are listed in the table below. Of particular interest are the questions on out-of-pocket expenditure and household expenditure to enable the calculation of financial risk protection for all medical interventions captured by the DHS (both surgical and medical), a core component of Sustainable Development Goal 3.8. The remaining questions were taken from a successful pilot DHS survey in Zambia. In the development of this application, we have been fortunate to count on a number of international partners to provide expert review and the indicators proposed are a culmination of these consensus building discussions. Please refer to Appendix A for a full list of international stakeholders who support this application.

Proposed Indicators:
1. Risk of impoverishing and catastrophic expenditure

Data Utility:
1. World Bank: World Development Indicators
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #16990 is a reply to message #16801] Thu, 14 March 2019 20:08 Go to previous messageGo to next message
taylorwurdeman is currently offline  taylorwurdeman
Messages: 6
Registered: March 2019
Member
Data on household expenditure is interesting to multiple fields, including specifically the fields of economics and healthcare research. Until we collect this data, we cannot get a true understanding of how healthcare costs influence decisions made. This will also support the development of national health plans (including national surgical plans). I agree that this measure should be included in the DHS survey.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17076 is a reply to message #16801] Fri, 15 March 2019 10:44 Go to previous messageGo to next message
Scott Corlew is currently offline  Scott Corlew
Messages: 6
Registered: March 2019
Location: Boston, MA
Member

Similar to the OOP expenditure module, the questions submitted here are critical for the assessment of financial risk protection related to surgical care as part of UHC. DHS data would be the missing link of hard data to augment and replace the modeled data now used.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17122 is a reply to message #17076] Fri, 15 March 2019 14:27 Go to previous messageGo to next message
djumbam is currently offline  djumbam
Messages: 5
Registered: March 2019
Member
Household expenditure, similar to out-of-pocket expenditure, is essential for tracking risk of impoverishment for seeking surgical and medical care. I highly encourage the DHS to consider including this indicator in the new module.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17131 is a reply to message #16801] Fri, 15 March 2019 14:42 Go to previous messageGo to next message
dominiquevervoort is currently offline  dominiquevervoort
Messages: 4
Registered: March 2019
Member
On behalf of students and residents around the world, I encourage DHS to include total household expenditure on surgical care. Receiving surgery requires costs for the procedure, but also very much so transportation costs, food costs, sleeping costs, opportunity costs - all of which contribute to an enormous financial burden for individuals and families. Understanding how heavy this weighs on pushing patients (further) into poverty is essential to reduce catastrophic expenditure efficiently and work towards universal health coverage globally.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17149 is a reply to message #16801] Fri, 15 March 2019 15:06 Go to previous messageGo to next message
ptruche is currently offline  ptruche
Messages: 6
Registered: March 2019
Member
Tracking expenditures for non-communicable diseases, specifically surgery represents an opportunity for the DHS to promote thoughtful and economically based improvement of surgical systems. This would be a critical data point to add to the DHS.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17157 is a reply to message #16801] Fri, 15 March 2019 15:16 Go to previous messageGo to next message
vsanthirapala is currently offline  vsanthirapala
Messages: 5
Registered: February 2019
Member
As national governments move towards the delivery of SDG target 3.8, universal health coverage (such as India's Ayushman Bharat), collection of data on impoverishing and catastrophic healthcare expenditure will be of key importance. Yet the data point that is most commonly lacking for this calculation is an accurate estimate of Total Household Expenditure from the healthcare user's perspective. Without this how can we begin to evaluate the impact of national healthcare plans? These questions are essential to all sectors of public health and so I believe it is completely appropriate to place these questions in the core household module.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17166 is a reply to message #17157] Fri, 15 March 2019 15:24 Go to previous messageGo to next message
anm156 is currently offline  anm156
Messages: 4
Registered: March 2019
Member
Data on household expenditure is necessary in order to understand Universal Health Coverage in a country and around the world. Data on UHC related to household expenditure and health care expenditure is sparse and not standardized. This directly affects quality of the data and conclusions that can be drawn from this data. In order to achieve SDG targets for Universal Health Coverage, a proper assessment of health care access related to household expenditure and out-of-pocket expenditure must take place. Efforts such as the DHS can go a long way to achieve this.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17178 is a reply to message #17166] Fri, 15 March 2019 15:29 Go to previous messageGo to next message
Vicente Gracias is currently offline  Vicente Gracias
Messages: 5
Registered: March 2019
Member
I completely support the aspirational goal of UHC for all. this is impactful work that must be supported
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17185 is a reply to message #17178] Fri, 15 March 2019 15:42 Go to previous messageGo to next message
Jordan Pyda is currently offline  Jordan Pyda
Messages: 4
Registered: March 2019
Member
Critical data, along with OOP costs which must be collected to gain insight into the critical importance of surgical care... no survey like the DHS for this data to be comprehensively and systematically collected. Jordan Pyda MD, MPH jpyda@bidmc.harvard.edu
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17194 is a reply to message #17185] Fri, 15 March 2019 15:54 Go to previous messageGo to next message
RPatterson is currently offline  RPatterson
Messages: 5
Registered: March 2019
Member
There has long been a belief that surgery is too expensive too provide. In fact, it seems the more accurate and pressing reality is that patients are unable to afford surgery, and that inadequate financing mechanisms lead to high percentages of patients suffering untenable expenses. This problem has not been thoroughly defined, and an understanding of OOP costs is essential to create effective national surgical policy.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17195 is a reply to message #17194] Fri, 15 March 2019 15:57 Go to previous messageGo to next message
bujarqerreti is currently offline  bujarqerreti
Messages: 2
Registered: March 2019
Member
Financial arrangements have always been a challenge of healthcare system because the dynamic of healthcare governance and services require financial adaptability. Catastrophic expenditure is a neglected issue of the financial arrangements in the global healthcare; therefore, we have to include the risk of impoverishing and catastrophic expenditure in the DHS because this is an issue that has a direct impact on the family as a social institution. Working towards the improvement of the situation of catastrophic expenditure would improve the life of families and at the same time would create a more sustainable management within family members (shared healthcare).
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17204 is a reply to message #16801] Fri, 15 March 2019 16:08 Go to previous messageGo to next message
JohnMeara is currently offline  JohnMeara
Messages: 10
Registered: March 2019
Location: Boston, MA, USA
Member

I support the collection of household expenditure as a means of better understanding catastrophic and impoverishing expenses around surgical care
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17209 is a reply to message #16801] Fri, 15 March 2019 16:09 Go to previous messageGo to next message
rachelne is currently offline  rachelne
Messages: 5
Registered: March 2019
Member
This information is so important and this is necessary to further understand costs and burdens to individuals and families
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17215 is a reply to message #16801] Fri, 15 March 2019 16:12 Go to previous messageGo to next message
blakealkire is currently offline  blakealkire
Messages: 5
Registered: March 2019
Member
The capital and operating costs in surgery have repeatedly been shown to be dwarfed by the positive benefits surgical systems bring to the economy and, more importantly, to improved population health. Unfortunately, those costs continue to be passed on to patients with devastating consequences. These data are essential to measuring progress to true UHC, which requires that patients are not impoverished for paying for healthcare.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17222 is a reply to message #16801] Fri, 15 March 2019 16:17 Go to previous messageGo to next message
Cstrader1 is currently offline  Cstrader1
Messages: 8
Registered: March 2019
Member
The poorest one-third of the global population receives only 6% of surgeries globally, well below their actual need. This disparity is only going to increase in the next decades as non-communicable diseases become an even greater proportion. Timely access to safe and adequate surgical care is needed to address this disparity. These additions to the DHS Survey is certainly a step towards this goal.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17224 is a reply to message #17209] Fri, 15 March 2019 16:18 Go to previous messageGo to next message
shehnaz Alidina is currently offline  shehnaz Alidina
Messages: 4
Registered: March 2019
Member
I support the collection of household expenditure so that we can fully understand understand the catastrophic expenditure related to surgery care.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17227 is a reply to message #16801] Fri, 15 March 2019 16:18 Go to previous messageGo to next message
AlexPetersMD is currently offline  AlexPetersMD
Messages: 8
Registered: March 2019
Member
As a general surgeon and public health research, I fully support these efforts. If we are going to drive forward universal health coverage, which includes surgical care as declared in WHA Resolution 68.15, we need to better understand household expenditures and those expenditures that are impoverishing or catastrophic for families. These are critical questions that must be included in future data collection. Thank you for these efforts.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17232 is a reply to message #16801] Fri, 15 March 2019 16:20 Go to previous messageGo to next message
shrime
Messages: 3
Registered: March 2019
Member
Universal health coverage is more than just making sure people get care. It's making sure that care doesn't impoverish them. Without data about their household expenditures, the global community cannot work to prevent the impoverishment that patients face when accessing care
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17243 is a reply to message #16801] Fri, 15 March 2019 16:24 Go to previous messageGo to next message
cjuillard is currently offline  cjuillard
Messages: 4
Registered: March 2019
Member
I fully support the addition of this indicator, which is essential to improve access to surgical care by understanding the financial impact of seeking formal care for surgical conditions.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17245 is a reply to message #16801] Fri, 15 March 2019 16:24 Go to previous messageGo to next message
Haitham.Shoman is currently offline  Haitham.Shoman
Messages: 4
Registered: March 2019
Member
Collecting primary data to understand the proportion of costs being spent on healthcare is an essential element to identify risk of catastrophic and impoverishing expenditures as laid out by the Lancet Commission on Global Surgery.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17247 is a reply to message #16801] Fri, 15 March 2019 16:25 Go to previous messageGo to next message
bat1117 is currently offline  bat1117
Messages: 1
Registered: March 2019
Member
The devastating overall impact, specifically emotional and financial, of trauma, necessary surgery and post-operative care persists far beyond the incident or progressing and mounting episodes. I believe we all agree. Are there plans to develop systems and programs that support ongoing post-operative policies that will provide patients (lower income patients) centralized (or even decentralized) healthcare information services to which they can access for questions and concerns after their surgery has been completed? May I recommend that such "tertiary services" be debated in terms of the long-term benefit for surgical patients and families. The surgical costs, being relatively enormous, at this time, might preclude lower/middle income patients and families from seeking ongoing more long-term care information from fear of driving up personal costs. If sustainable post-operative health care "information-access" systems and services were available for these populations, overall healing and survival might demonstrate increases and the costs for delays in accessing care could be averted.

I commend the valiant efforts of global surgical advocates and it is an honor to serve with any of them. Nevertheless, I advocate that surgical efforts for ALL lower income patients result in success. Providing health information and responding to surgical patient questions (without driving) up post-operative costs seems achievable though an innovative systems approach.

Please, consider the value of post-operative health and care information access systems. The long-term payoff for sequential informaition systems and services could be powerful!

[Updated on: Fri, 15 March 2019 16:27]

Report message to a moderator

Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17279 is a reply to message #16801] Fri, 15 March 2019 16:42 Go to previous messageGo to next message
SebastianShu is currently offline  SebastianShu
Messages: 5
Registered: March 2019
Member
For families, diverting more money for health care expenditure can produce a direct impact their well being or affecting important components such as education. It is vital to collect improve quality data to understand how much is being spend by the basic unit of society.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17283 is a reply to message #16801] Fri, 15 March 2019 16:45 Go to previous messageGo to next message
gmenon is currently offline  gmenon
Messages: 8
Registered: March 2019
Member
Knowing average household expenditure is critical to several fields. I fully support its inclusion.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17291 is a reply to message #16801] Fri, 15 March 2019 16:51 Go to previous messageGo to next message
SBari is currently offline  SBari
Messages: 4
Registered: March 2019
Member
This is an important indicator and is necessary to collect regularly, systematically, and globally. DHS is a great fit.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17296 is a reply to message #17283] Fri, 15 March 2019 16:57 Go to previous messageGo to next message
Ulrick Sidney is currently offline  Ulrick Sidney
Messages: 4
Registered: March 2019
Location: Cameroon
Member

Most of those who do not have access to safe surgery are people who live under USD 1,50 a day and do not have access to a reliable national insurance. For these families going to the hospital means that they have to foot the bill and this has more than just an economic impact. In some families the getting surgical care means selling their properties, selling their livestock, giving up on the education of their kids or borrowing money from loan sharks. It is therefore important to collect data on household (surgical) health expenditure.

Ulrick Sidney
InciSioN International Team
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17298 is a reply to message #17283] Fri, 15 March 2019 17:00 Go to previous messageGo to next message
Adelina Mazhiqi is currently offline  Adelina Mazhiqi
Messages: 4
Registered: March 2019
Member
It's not just access to safe and timely surgical care; such care care must also be affordable. Because primary data on household expenditure is limited, and since we can't manage what we don't measure, the questions suggested for the DHS tool enables us to understand the financial impact of seeking surgical care; thus, I fully support the inclusion of these indicators.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17301 is a reply to message #16801] Fri, 15 March 2019 17:05 Go to previous messageGo to next message
CLReddy is currently offline  CLReddy
Messages: 5
Registered: March 2019
Member
I support the collection of household expenditure. This data is indispensable to calculate surgical catastrophic and impoverishing expenses. Without this data, the sustainable development goal of UHC will be difficult to attain in terms of coverage to essential surgical services.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17315 is a reply to message #16801] Fri, 15 March 2019 17:31 Go to previous messageGo to next message
Rachel Koch is currently offline  Rachel Koch
Messages: 4
Registered: March 2019
Member
I support inclusion of this question in the DHS survey as total expenditure is the preferred way to estimate household capital track financial burdens incurred by healthcare costs.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17320 is a reply to message #16801] Fri, 15 March 2019 17:33 Go to previous messageGo to next message
PGSSC is currently offline  PGSSC
Messages: 10
Registered: March 2019
Location: Boston, USA
Member
We would like to thank everyone who have been supporting our submission. We have read all your replies and we are delighted to see such support and commitment from the Global Surgery and Global Health community.

Attached is a list of signatories who also have provided their support towards our submission:

1. Professor Chris Lavy - University of Oxford
2. Mr. Andrew Leather - Kings College London
3. Dr. Lars Hagander - Lund University
4. Dr. Hampus Holmer - Lund University
5. Dr. Martin Veller - University of Witwatersrand
6. Dr. Emannuel Ameh - Abuja National Hospital
7. Dr. Margaret Kruk - Harvard TH Chan School of Public Health

The Program in Global Surgery and Social Change (PGSSC)
Harvard Medical School
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17327 is a reply to message #16801] Fri, 15 March 2019 17:43 Go to previous messageGo to next message
Dr. Ernest Barthélemy is currently offline  Dr. Ernest Barthélemy
Messages: 6
Registered: March 2019
Member
As an American neurosurgeon working in Haiti, I have been in the unfortunate position of witnessing families refusing life-saving interventions for their sick family members because of fear that the cost of these interventions would financially ruin the entire family. In this uniquely low-income country in the Americas, understanding and tracking the risk of impoverishing and catastrophic expenditure is an absolutely essential part of strengthening the health system through scale-up of surgical capacity. I therefore wholeheartedly support the inclusion of this indicator in the DHS.


PGSSC wrote on Tue, 05 March 2019 17:28
The questions we propose are a product of the Lancet Commission on Global Surgery (LCoGS), a body of work spanning three years involving 25 commissioners and a diverse group of academic, governmental and civil society collaborators from 110 countries. Of the six indicators proposed by the LCoGS, four were published in the World Development Indicators by the World Bank and all six are included in the World Health Organization's Global Reference List of 100 Core Health Indicators. Nevertheless, there currently are no mechanisms in place to collect the data required for these indicators, creating a critical gap in knowledge for surgical care strengthening.

The new indicators in this proposal span four existing DHS modules. For clarity, they are listed in the table below. Of particular interest are the questions on out-of-pocket expenditure and household expenditure to enable the calculation of financial risk protection for all medical interventions captured by the DHS (both surgical and medical), a core component of Sustainable Development Goal 3.8. The remaining questions were taken from a successful pilot DHS survey in Zambia. In the development of this application, we have been fortunate to count on a number of international partners to provide expert review and the indicators proposed are a culmination of these consensus building discussions. Please refer to Appendix A for a full list of international stakeholders who support this application.

Proposed Indicators:
1. Risk of impoverishing and catastrophic expenditure

Data Utility:
1. World Bank: World Development Indicators
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17332 is a reply to message #17327] Fri, 15 March 2019 17:46 Go to previous messageGo to next message
Kee Park is currently offline  Kee Park
Messages: 5
Registered: March 2019
Member
Total Household Expenditure complements the OOP expenditure and provides a clearer picture families face in accessing healthcare including surgical care.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17351 is a reply to message #17332] Fri, 15 March 2019 18:13 Go to previous messageGo to next message
LukeCaddell is currently offline  LukeCaddell
Messages: 4
Registered: March 2019
Member
This data is needed. A better understanding of total household expenditure will help describe impoverishing and catastrophic health expenditure by bringing a better understanding of how the entire family unit must respond to health care needs. The global health community needs this data to understand how our interventions are impacting the societies in which they act.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17357 is a reply to message #17351] Fri, 15 March 2019 18:33 Go to previous messageGo to next message
Aboatin is currently offline  Aboatin
Messages: 5
Registered: March 2019
Member
Without financial risk protection against improvising or catastrophic health expenditures universal health care is unachievable and we will fall short as a global community in achieving SDG 3. Measuring out of pocket expenditures and total health expenditure is critical to understand progress made towards achieving financial risk protection. The DHS presents an optimal way to collect this information which has yet to be collected in a standardized manner and on a large scale.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17389 is a reply to message #16801] Fri, 15 March 2019 21:44 Go to previous messageGo to next message
Jacob.Lepard is currently offline  Jacob.Lepard
Messages: 5
Registered: March 2019
Member
I support the use of the proposed metrics in this module. A broader picture of household expenditure is necessary in order to fully grasp the financial hurdles that are present for access to global surgical care.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17395 is a reply to message #16801] Fri, 15 March 2019 22:14 Go to previous messageGo to next message
ryorlets is currently offline  ryorlets
Messages: 2
Registered: March 2019
Member
Universal health coverage cannot be achieved without the assurance of financial risk protection. This module proposes the collection of data which will enable the calculation of catastrophic and impoverishing expenditure.
Re: DHS-8-PGSSC-Total_Household_Expenditure-Template [message #17400 is a reply to message #17395] Fri, 15 March 2019 22:27 Go to previous message
IsaacWasserman is currently offline  IsaacWasserman
Messages: 8
Registered: March 2019
Member
As powerful as modeling studies are, the only way to progress past the realm of the theoretical, and anchor ourselves in the realm of the real is to collect robust data. When surgery playing a role in nearly 1/3rd of all human disease, I can think of no better area to invest in better data collection. This will help evaluate ongoing projects, as well as steer new ones. Thank you for expanding into this important sphere.
Previous Topic: Alcohol consumption
Next Topic: DHS-8-PGSSC-Men_and_Women-Template
Goto Forum:
  


Current Time: Wed Nov 25 17:20:44 Coordinated Universal Time 2020