This study investigates the effect of a disabling health shock, injury, on household health expenditure and welfare in Zambia before and after 2002, a year that marks an end to a period of tightening structural reforms. Results show that injury was associated with lower consumption and reduced earned income in both periods. Injury almost doubled health expenditure after 2002, an effect which was more modest before 2002. Households relied on informal borrowing and selling assets as self‐insurance strategies. These findings suggest that social protection programmes should not only focus on health insurance but also labour income protection.

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