Reviewed by Josefien Van Olmen

For international health, this ppaper does not render new insights about out of pocket expenditure, equity in health care utilisation and payment mechanims. For that, its methodology (cross sectional survey with questionnaires) and scope of the research were too limited.

It would have been much more interesting to do qualitative analysis, for instance by indepth interviews, to better understand why people behave the way they do. The paper might (hopefully) be of value to local policy makers, helping them to understand the dynamics among their constituency populations. The authors performed this study with funding from the Alliance for Health Policy and Systems Research. Does that fit into strategies of the Alliance to build local health systems research capacity in low income countries? It could be a very modest start, but still a way to go. 

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