Abstract:
Introduction
The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income
countries, including Kenya, disproportionately to the rest of the world. Our objective was to
quantify patient payments to obtain NCD screening, diagnosis, and treatment services in
the public and private sector in Kenya and evaluate patients' ability to pay for the services.
Methods and findings
We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer,
and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital,
and the Kibera South Health CenterÐa public outpatient facility, and private sector
practitioners and hospitals. We developed detailed treatment frameworks for each NCD and
used an itemization cost approach to estimate payments. Patient affordability metrics were
derived from Kenyan government surveys and national datasets.
Results compare public and private costs in U.S. dollars. NCD screening costs ranged
from $4 to $36, while diagnostic procedures, particularly for breast and cervical cancer,
were substantially more expensive. Annual hypertension medication costs ranged from $26
to $234 and $418 to $987 in public and private facilities, respectively. Stroke admissions
($1,874 versus $16,711) and dialysis for chronic kidney disease ($5,338 versus $11,024were among the most expensive treatments. Cervical and breast cancer treatment cost for
stage III (curative approach) was about $1,500 in public facilities and more than $7,500 in
the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health
insurance, which makes NCD services unaffordable for most people given the overall high
cost of services relative to income (average household expenditure per adult is $413 per
annum).
Conclusions
There is substantial variation in patient costs between the public and private sectors. Most
NCD diagnosis and treatment costs, even in the public sector, represent a substantial economic
burden that can result in catastrophic expenditures.
