Non - medical out of pocket expenditure associated with cataract surgery in a general hospital in Zaria, Kaduna State, Nigeria

Abstract

In Nigeria, healthcare financing is predominantly out-of-pocket (OOP), with non-medical costs contributing significantly to the overall burden, especially among the poor and elderly. This study assesses the non-medical OOP expenditures incurred by patients and their companions undergoing cataract surgery at Hajiya Gambo Sawaba General Hospital, Zaria. A cross-sectional survey design
was employed using structured, interviewer-administered questionnaires. A total of 100 cataract patients (or their companions) were purposively selected based on their surgical history within the past 12 months. Data on transportation, lodging, meals, medications, laboratory tests, and payment sources were collected and analyzed using descriptive statistics. The majority of respondents were aged 46 years and above (56%), male (62%), and retirees (40%). Notably, 82% had paid for cataract surgery, with 84% using personal funds and only 16% accessing National Health Insurance Scheme (NHIS) coverage. About 87% reported that escort-related costs significantly contributed to treatment expenses. Additionally, 33% borrowed money to finance care, and 71% acknowledged spending more than they could afford. Non-medical OOP expenditures—particularly transport, lodging, and companion support—pose critical barriers to cataract surgery, even when surgical fees are subsidized. The findings underscore the need for expanded insurance coverage, patient support schemes, and policy reforms targeting non-medical costs to improve access and reduce the burden of avoidable blindness.