Time, health service utilisation and health status in Africa: Evidence from six countries

Abstract The debate on mechanisms for health‐care financing in sub‐Saharan Africa since the pre‐independence days has focused on roles of markets and governments in mobilising resources to finance health services, with little or no awareness of the role played by the household time allocations across everyday tasks. The paper first examines the response of health service utilisation to monetary prices of care and to the time costs of fetching water and firewood. Next it estimates the effect of service usage on health status using comparable survey data from Ethiopia, Ghana, Kenya, Malawi, Niger and Uganda. The main finding of the study is that health service utilisation is negatively associated with the monetary and time costs incurred to access health facilities, but the effect of service usage on health status in the study samples is generally positive. The evidence from this study and that from previous investigations in the field, both suggest that a broad‐based health‐care financing strategy in sub‐Saharan Africa should include affordable user charges, local level public provision of social insurance and water supplies, as well as investments in domestic fuel technologies and transportation infrastructure directed at reducing time poverty.