Chronic illness and poverty: Exploring the links

One major component of work on social protection and heath within the Future Health Systems programme is the POVILL (Poverty and Illness) research project. This was designed to better understand the potentially complex impacts of serious ill-health in rural areas of China, Cambodia and Laos. It focused on ‘major illnesses’, health problems with the potential to seriously damage household livelihood strategies and increase the risk of impoverishment.

Almost one-third of such conditions in China and over 20% in Cambodia related to chronic illness. The poorest households with a member suffering from chronic disease in China reported an average US$380 expenditure on outpatient care, compared to an average per capita income of around US$450. They typically received no support from the recently introduced New Cooperative Medical System (NCMS) unless they also required in-patient treatment. Most of the care purchased was unnecessary or sub-standard. In Cambodia, similarly defined households reported spending an average 30% of annual household income on heathcare. Again, very limited support was available from the local Health Equity Fund (HEF).

Comparable findings have been reported by the China Health Economics Institute, which is overseeing a review of the NCMS, and the Indian Institute of Health Management Research which conducted a similar study in West Bengal.

Another outcome from POVILL has been support for an innovative approach to diabetes diagnosis and management in Cambodia. The MoPoTsyo Patient Information Centre is an NGO that uses based ‘peer educator’ approach. It establishes patient networks, provides information on self-management, advice and counselling, and mediates between these networks and public and private doctors, pharmacists and other service providers.

Chronic illness centre at ICDDR,B Bangladesh launched
in June 2009.This is one of the six centres of excellence funded by NHLBI.

>> Read the press release
>> Read comment in the Lancet
>> ICDDR,B information on the centre

Further reading

Chronic Disease Newsletter, November 2009

H. Lucas; S. Ding; G. Bloom What do we mean by 'major illness'?: the need for new approaches to research on the impact of ill-health on poverty Studies in Health Services Organisation and Policy, 2008

Kanjilal B, Mukherjee M, Singh S, Mondal S, Barman D, Mandal A Health, Equity and Poverty Exploring the Links in West
Bengal, India. FHS Working paper 4, India series, December 2007

Draft papers on diabetes

Van Pelt M, Lucas H, Men C, Vun O, Van Damme W
Yes, they can. Peer Educators for diabetes in Cambodia

Men C R, Meessen B, Van Pelt M, Van Damme W, Lucas H “I Wish I Had AIDS”: Qualitative study on access to health care services for patients with diabetes and HIV/AIDS in Cambodia