Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents

BMJ Open. 2021 Jul 9;11(7):e045441. doi: 10.1136/bmjopen-2020-045441.


Introduction: People living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents.

Methods and analysis: This scoping review adopts the framework suggested by Arksey and O'Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported.

Ethics and dissemination: Ethical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.

Keywords: health economics; health policy; health services administration & management; protocols & guidelines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bangladesh
  • COVID-19*
  • Developing Countries
  • Female
  • Health Facilities
  • Health Services Accessibility / economics*
  • Humans
  • India
  • Kenya
  • Male
  • Pandemics
  • Poverty Areas*
  • Review Literature as Topic
  • SARS-CoV-2
  • Sierra Leone