Multiple projects on the analysis of Financial Risk Protection Indicators in Resource-Limited Country Setting for general and gynaecological surgery

Background Access to timely and safe surgical care is a crucial component of universal health coverage. In resource-limited settings, however, the financial burden associated with essential surgeries can be substantial, often resulting in catastrophic health expenditures (CHE) and impoverishment. Among the most commonly performed and life-saving procedures are caesarean sections (C-sections) for obstructed or complicated labour, paediatric surgeries such as hernia repair or correction of congenital anomalies, and emergency general surgeries including appendectomy for acute appendicitis, surgical management of bowel perforation, and treatment of intussusception, particularly in children. Despite being critical to reducing morbidity and mortality, these procedures frequently require significant out-of-pocket (OOP) spending, especially when performed in emergencies or in the absence of prepayment or insurance coverage. In such contexts, surgical care can push households into financial distress, undermining both health and economic resilience. Financial Risk Protection (FRP) indicators — such as the prevalence of CHE and the incidence of impoverishment — provide key insights into the extent to which health systems protect individuals and families from financial hardship. Measuring and analysing these indicators is essential for informing policy decisions and strengthening health financing strategies that support equitable access to surgical care. This multi-project initiative seeks to explore FRP for a range of essential surgical services, with a particular focus on general and gynaecological surgeries, in a resource-limited country. The aim is to generate actionable evidence that can guide health system reforms and improve financial protection for surgical patients. Example scenario: Caesarean section (C-section) is a critical surgical procedure to address complications during childbirth. However, in resource-limited settings, the financial burden of C-sections can be substantial, affecting households' economic stability and access to healthcare. Financial risk protection indicators are essential for assessing the extent to which healthcare systems protect individuals from catastrophic and impoverishing healthcare expenditures. Understanding financial risk protection for C-sections in resource-limited settings is crucial for informing policy and improving healthcare financing strategies. This study aims to analyse financial risk protection indicators in a specific resource-limited country to identify gaps and propose actionable recommendations. Primary Objective To assess financial risk protection related to general and gynaecological surgical care in a resource-limited country setting. Secondary Objectives To determine the prevalence of catastrophic health expenditures due to selected surgical procedures. To analyse the incidence of impoverishment resulting from OOP payments for surgical care. To explore socioeconomic and systemic factors associated with financial vulnerability in surgical care. To formulate actionable policy recommendations to strengthen financial risk protection in surgical services. Study Design Cross-sectional descriptive and analytical studies conducted as parallel or sequential projects. Study Setting The studies will be implemented in low and middle Countries, covering a mix of urban and rural healthcare facilities that provide general and gynaecological surgeries. Data Collection Secondary data sources such as national household surveys, hospital billing records, and national health accounts will be used. Key indicators include: Household income and expenditure data Utilization and cost of general and gynaecological surgeries OOP expenditures and insurance coverage Availability of financial risk protection mechanisms Sampling Stratified random sampling will be applied to select households and facilities to ensure representation across socioeconomic strata and regions. An estimated [sample size] households with recent surgical experiences will be included. Data Analysis Quantitative data will be analysed using software such as Stata or SPSS. Key analyses include: Estimation of CHE and impoverishment indicators Regression models to identify predictors of financial risk exposure Descriptive statistics to characterise the study population and service utilization patterns Ethical Considerations Ethical approval will be obtained from the relevant Institutional Review Board. Informed consent will be secured from all participants, and confidentiality will be maintained throughout. Expected Outcomes A detailed assessment of financial risk protection for general and gynaecological surgical care in the selected setting Identification of key gaps and determinants in current FRP mechanisms Evidence-based, context-specific policy recommendations to enhance equitable access and reduce financial hardship from surgical care