Medical emergencies and farm productivity in Côte d'Ivoire

• Published date: 01 August 2023
• Author: Gabriel Picone,Assi José Carlos Kimou,Désiré Kanga
• Date: 01 August 2023
• DOI: http://doi.org/10.1111/rode.12987

REGULAR ARTICLE

Medical emergencies and farm productivity

in Côte d'Ivoire

Gabriel Picone

1

| Assi José Carlos Kimou

2

| Désiré Kanga

3

1

University of South Florida, Tampa,

Florida, USA

2

Université Félix-Houphouët-Boigny

(UFHB), Abidjan, Ivory Coast

3

Ecole Nationale de Statisitique et

d'Economie Appliquée (ENSEA),

Abidjan, Ivory Coast

Correspondence

Assi José Carlos Kimou, Université Félix-

Houphouët-Boigny (UFHB), Abidjan,

Ivory Coast.

Email: assikimou@gmail.com

Funding information

African Economic Research Consortium

(AERC), Grant/Award Number: RC18550

Abstract

The lack of health insurance for smallholder farmers in

most sub-Saharan African countries hurts the families and

can also negatively affect agriculture production, exports,

and tax revenues. This paper analyzes the linkage between

medical emergencies and agriculture exports and the

corresponding tax revenues for smallholder farmers in

Côte d'Ivoire. It uses two complementary datasets: the

2016 Consultative Group to Assist the Poor (CGAP) small-

holder survey and the 2015 Côte d'Ivoire living standard

survey. The paper finds that a medical emergency is nega-

tively and significantly associated with a decrease in the

likelihood that a smallholder farmer cultivates cocoa of 3.9

percentage points, driving them into poverty and reducing

productivity at the lower quantiles. The paper then esti-

mates that medical emergencies can be correlated with the

decline in cocoa exports of $853 million and in tax reve-

nues of $125 million, representing 0.2% of the Ivorian gross

domestic product (GDP) in 2017.

KEYWORDS

medical emergencies, small farmholders, Côte d'Ivoire

JEL CLASSIFICATION

C25, C2, C, I15, I1, I, J43, J4, J, N77, N7, N, O12, O1, O

1|INTRODUCTION

Illness is a common concern for families, impairing their productivity. Serious illness can affect

cognitive ability, psychomotor functions, and several attributes that can negatively decrease

Received: 4 September 2021 Revised: 10 May 2022 Accepted: 28 February 2023

DOI: 10.1111/rode.12987

1630 © 2023 John Wiley & Sons Ltd. Rev Dev Econ. 2023;27:1630–1648.wileyonlinelibrary.com/journal/rode

productivity at work (Cockburn, Bailit, Berndt, & Finkelstein, 1999). While access to affordable

and effective healthcare could be helpful to mitigate the adverse effects of disease, unmet

healthcare needs are still a considerable challenge for sub-Saharan African countries despite

recent economic performance.

Côte d'Ivoire experienced noticeable economic growth over the last decade, averaging 7%

growth in gross domestic product (GDP) annually. Despite that positive economic dynamic,

healthcare has not been a significant priority of the Ivoirian government. Duran, Sieleunou,

and Özaltin (2020) showed that, between 2014 and 2018, the government of Côte d'Ivoire

devoted less than 5% of its budget to healthcare financing, largely below the Abuja declaration.

Although public investment in health is a pro-poor expenditure, health has grown less than

other public spending. Consequently, Côte d'Ivoire is still exhibiting a low-income epidemio-

logic profile despite its low-to-medium-income status. Compared with other sub-Saharan coun-

tries, 17% of the population is pushed into poverty due to out-of-pocket spending (Duran

et al., 2020.). This effect occurs less in urban areas than in rural areas, where most agricultural

activities occur.

Indeed, the vast majority of the agriculture production in Côte d'Ivoire comes from small-

holder farmers who own small plots of land on which they grow subsistence crops and one or

two cash crops and rely almost exclusively on family labor. As a result, smallholder farmers live

near poverty and lack protection against income shocks. In rural areas, the incidence of poverty

is 56.8%, compared with 35.9% in urban areas. In addition, the contribution of rural populations

to poverty is 61.2% (National Institute of Statistics [INS], 2015).

Thus, when facing significant medical expenses, these farmers are likely to rely on funds

that would have been used to purchase agricultural supplies, lowering their productivity. For

instance, in 2015, households (HHs) spent 2.8% of their budget on health, with 2.6% for urban

areas and 3.2% for rural areas (INS, 2015). That situation can lead farmers to spend more time

on disease (OECD, 2020). In 2015, 65.1% of patients had been sick for less than 1 month, and

7.6% for more than 3 years. This disease duration is longer for the poor than for the non-poor.

On average, 28.2% of the poor patients were ill for between 1 month and 3 years, compared with

25.7% of non-poor patients (INS, 2015).

According to the World Health Organization (WHO), in 2015, less than 10% of the popula-

tion in Côte d'Ivoire has health insurance, while the rest of the population face significant out-

of-pocket expenditures when faced with medical emergencies (WHO, 2015). Unfortunately,

Côte d'Ivoire is not the exception in sub-Saharan Africa, where most households also lack ade-

quate health insurance coverage (WHO, 2015). Indeed, large out-of-pocket medical expenses

are a big factor that drives households into poverty in this region and highlights the need to

ensure access to healthcare for all individuals regardless of their income (Wagstaff, Flores, Hsu,

et al., 2017). The government of Côte d'Ivoire is aware of the importance of providing universal

health coverage and, in early 2000 and 2011, introduced a system that guaranteed free universal

health coverage for all of its population. Unfortunately, due to poor planning and lack of finan-

cial resources, this program quickly fell apart. The government replaced the program in 2012

with a policy that guarantees free care only for pregnant women and children under 5 years.

Moreover, even this lower target has not been met by most public health facilities due to a lack

of medicines and supplies (Ouattara, Houngbedji, & Koudou, 2013; Juillet, Konan, Hatt, Faye, &

Nakhimovsky, 2014). However, the government of Côte d'Ivoire has not abandoned its commit-

ment to universal health coverage (UHC), and in 2015 it started implementing a plan to provide

healthcare to all its citizens by 2020 (Dagnan, 2018).

PICONE ET AL.1631