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The paper contributes to emergent literature on the institutional context of informal health service provision, which is relevant to policy discourse in India, health system reform, and to marginalised populations the world over.

South Africa is considering major health service restructuring to move towards a universal system. This calls for understanding the challenges in the existing health system.

Objective: Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. Material and Methods: Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys.

Health policy and systems research (HPSR) is centrally concerned with people,
their relationships and the actions and practices they can implement towards