Assessment of the direct hospital cost of medical care for patients hospitalized for a stroke in Gabon.

While the incidence of stroke is increasing in developing countries, resulting in an extremely high economic burden, very few costing studies have been carried out to date. This study aims to measure the direct hospital costs of stroke management in Gabon. The study adopts a retrospective approach, based on a review of patient records in the Neurology and Cardiology Departments of the University Hospital of Libreville (CHUL) between January 2018 and December 2019. It focuses on all patients received for stroke at the CHUL during the study period, regardless of the outcome, analyzing direct hospital costs. Three hundred and thirteen (313) patients were admitted during the period in question, 72.52% in neurology and 27.48% in cardiology. The average age was 58.44 (±13.73 years). Fifty-six percent (56.23%) had health coverage. Ischemic stroke was more common than hemorrhagic stroke, at 79.55% and 20.45%, respectively. The average expenditure per patient was estimated at 619,633 CFA francs (€944.62). From the point of view of social security coverage, the average out-of-pocket expense per patient was 147,140 CFA francs (€224.31), for a reimbursement of 422,883 CFA francs (€644.68). The average direct cost of stroke is very high for both patients and administrations. This argues for the implementation of prevention programs for the disease. The results of this study may be useful for work on the efficiency of such programs.

État des lieux du système d'information sanitaire du Gabon.

OBJECTIVE: The need for an efficient and reliable health information system motivated Gabon, with the support of the World Bank, to finance a project to reinforce its health information system. An audit of this system was required to report on the reality of the existing system and tools. METHODS: Over the course of two periods, May to September 2016 and April to May 2018, information was collected using both qualitative and quantitative approaches. In this framework, were carried out successively: participative workshops including health actors in Gabon, a survey of health care workers, an analysis of reference documents relating to national health policies, and an analysis of the strengths, weaknesses, opportunities, and threats to the system. RESULTS: In total, 171 health care professionals participated in the different workshops, and 770 others were questioned among 150 health care establishments from 10 health care regions of the country. At the end of this research work, organizational and technical problems were noted at the level of the health information system of Gabon, notably the absence of a judicial framework defining the roles and responsibilities of the different actors of the system, weak data management, a stovepipe information system, several non-interoperable IT applications, and weak completeness rate, at 30%. Among the 770 health care professionals surveyed, 539 (70%) were favorable to a new information system. As for the main assets, we noted the existence of computing equipment and acceptable internet coverage, 31.5% of the health care establishments are connected via cable. CONCLUSION: This research sheds light on the existing health information system and should enable the implementation of a new system.