Impacts of firewood burning for cooking on respiratory health and healthcare utilisation: Empirical evidence from Sri Lankan micro-data.

Despite escalating income levels of Sri Lankan households, 70.3% of them still depend on firewood for cooking. This might lead to bad respiratory health and thereby, increased healthcare utilisation. With this backdrop, this paper examines how firewood burning for cooking influences respiratory health and healthcare utilisation of Sri Lankans. The study proposes a theoretical model to explain effects of firewood burning on respiratory health and healthcare utilisation and empirically tests it using nation-wide micro-data of 79,170 individuals belonging to 21,748 households. The data are drawn from the most recent wave of Sri Lankan household income and expenditure survey. After addressing potential endogeneity by applying instrumental variable regression models, the study finds that firewood burning increases households' probability of asthma prevalence by 10.9 percentage points (P < 0.001), out-patient care utilisation by 33.1 percentage points (P < 0.001), and in-patient care utilisation by 17.5 percentage points (P < 0.001), on average. Our individual level analysis demonstrates that females are more vulnerable to bad respiratory health induced by firewood burning (ß = 0.055, P < 0.001) compared to males (ß = 0.008, P > 0.1). The results imply policies on promoting improved-cooking stoves, separated-kitchen designs, and switching more towards cleaner energy sources, including LP gas and solar power.

The Global South political economy of health financing and spending landscape - history and presence.

The Global South nations and their statehoods have presented a driving force of economic and social development through most of the written history of humankind. China and India have been traditionally accounted as the economic powerhouses of the past. In recent decades, we have witnessed reestablishment of the traditional world economic structure as per Agnus Maddison Project data. These profound changes have led to accelerated real GDP growth across many LMICs and emerging countries of the Global South. This evolution had a profound impact on an evolving health financing landscape. This review revealed hidden patterns and explained the driving forces behind the political economy of health spending in these vast world regions. The medical device and pharmaceutical industry play a crucial role in addressing the unmet medical needs of rising middle class citizens across Asia, Latin America, and Africa. Domestic manufacturing has only been partially meeting this ever rising demand for medical services and medicines. The rest was complemented by the participation of multinational pharmaceutical industry, whose focus on investment into East Asia and ASEAN nations remains part of long-term market access strategies. Understanding of the past remains essential for the development of successful health strategies for the present. Political economy has been driving the evolution of health financing landscape since the establishment of early modern health systems in these countries. Fiscal gaps these governments face in diverse ways might be partially overcome with the spreading of cost-effectiveness based decision-making and health technology assessment capacities. The considerable remaining challenges ranging from insufficient reimbursement rates, large out-of-pocket spending, and lengthy lag in the introduction of cutting-edge technologies such as monoclonal antibodies, biosimilars, or targeted oncology agents, might be partially resolved only in the long run.

Household waste disposal mechanisms in Sri Lanka: Nation-wide survey evidence for their trends and determinants.

This study provides Sri Lanka-wide empirical evidence on trends and determinants of waste disposal mechanisms at household level over the past decade from 2007 to 2016. The study uses the data of 60,820 households from three waves of the Sri Lanka income and expenditure survey and estimates a multinomial logistic regression model. The descriptive statistics show that though Sri Lankan households predominantly burn waste (currently, 44.91 per cent of households), there is an emerging trend of shifting the main mechanism more towards waste collection arrangements. Urban and wealthier households headed by older and more literate individuals are more likely to use municipal waste collection arrangements. Also, older and more literate headship, larger land size, ownership of house, presence of spouse, and being in the richest expenditure quartile significantly increase the likelihood of composting. Burning and dumping waste within premises are preferred by the households representing various socio-economic subgroups except urban households. The results imply expansion of municipal services, implementing province-and sector-specific waste management policies, and promoting methods for safe burning and treating waste before dumping.

The effects of chronic non-communicable diseases on labour force outcomes: Quasi experimental evidence from Sri Lanka.

We investigate the effects of experiencing non-communicable diseases (NCDs) on labour force outcomes of working-age individuals and their households in Sri Lanka. For this, quasi-experimental evidence, including average treatment effects on those treated (ATT), are generated by using the self-reported health survey of the labour force of Sri Lanka. According to the analysis, individuals with at least one NCD account for approximately 19.15% of the working-age population. On average, employment probability, labour supply, and labour earnings of them are significantly lower than those of non-NCD individuals by 9.5% (ATT=-0.102, P < 0.001), 44.6% (ATT=-0.590, P < 0.001), and 47.9% (ATT=-0.652, P < 0.001), respectively. The negative impacts on labour force outcomes are notably larger in the cases of paralysis and mental illness. These NCDs reduce individual labour supply by more than 80% and labour earnings by more than 90%. The employment probability of individuals with paralysis and mental illnesses is also relatively lower by more than 60%. Apart from these individual-level effects, the paper provides evidence on how labour force outcomes at the household level are influenced by NCDs. Our findings demonstrate that the association between individuals' NCD-prevalence and labour force outcomes is relatively stronger for males, informal sector employees, and elderly people. The results suggest several social inclusion policies.

Impact of ill-health on household consumption in Sri Lanka: Evidence from household survey data.

With significant increases in chronic non-communicable diseases (NCDs) in recent years, Sri Lanka has witnessed a growing trend of increased out-of-pocket payments for healthcare, imposing a severe burden on household budgets. This is exacerbated by limited government health funding and inadequate financial security from formal social security. We examine the association of NCD-prevalence and healthcare utilization with household consumption, using the most recent Sri Lanka Household Income and Expenditure Survey 2012/2013. The unit of analysis is the household. We use data for 20,535 households to apply two-part models. Findings suggest that financial constraints induced by NCD-prevalence and hospitalization compel households primarily to sacrifice food consumption. Analysis further shows that poorer households are more vulnerable to food insecurity arising from these. Households sacrifice the basic needs of housing and clothing, and the burden on poorer households is higher, whereas richer households have the option of sacrificing more from non-basic needs to cope with NCDs and hospitalization and thereby to secure basic needs to a certain extent. Moreover, the burden of out-of-pocket healthcare expenses is found to be positively associated with NCDs and hospitalization. In addition to the direct association, public hospitalization favorably moderates the associations between NCDs and the allocations for food and healthcare. Private hospitalization is adversely associated with a wider range of consumption, creating negative welfare consequences. These findings provide valuable information on what needs to be done to reform Sri Lanka's health sector. The study contributes to international discussions on frameworks and national-level policies for effectively allocating public and private funds to the health sector to mitigate hardships faced by the poorest households.

Patterns and determinants of out-of-pocket health care expenditure in Sri Lanka: evidence from household surveys.

This article examines patterns and determinants of the likelihood and financial burden of encountering out-of-pocket healthcare expenses in Sri Lankan households as, on average, more than 60% of households incur such costs. This percentage varies substantially across household categories in demographic properties, sectors and ability-to-pay. Households comprising more than one elderly person, pre-school children, members with chronic illnesses, and literate household heads are at significant risk of incurring out-of-pocket payments and bearing a higher financial burden. Rural and estate sector households are more likely to bear a higher burden. The marginal effects of household income show that the burden of private healthcare is less sensitive towards changes in household income and that households' burden in private healthcare was regressive in 2006/2007. Hence results imply that low-income households need to be protected. Analysis of supply side factors shows that availability of closer government hospitals, bed numbers and dentists in government hospitals reduce the burden of out-of-pocket expenses. However, more government doctors lead to higher likelihood and burden of incurring such healthcare expenses and create a government-doctor-induced cost. Therefore, the results show a convincing need for the expansion of healthcare infrastructure by government and a policy framework for its doctors that will lessen the financial burden in Sri Lankan households, particularly the poor.