There has been limited data on the impact of out-of-pocket health payments (OOPs) on extreme poverty in Guinea. Yet, these data are necessary for making informed decisions in the fight against poverty. This paper aimed to (i) measure the impact of OOPs on extreme poverty in Guinea, (ii) compare this impact with that of other household expenditure categories, and (iii) assess the alignment of health financing with this impact. The paper utilized data from the 2018-19 Living Standards Measurement Study and the 2020-24 health financial commitments of the State and its partners, and is based on the impoverishing expenditure method. The three most common poverty measures were used: (i) prevalence, which refers to the number of people in a given population living below a given poverty line
(ii) normalized gap, which estimates the amount needed to eradicate poverty in a given population
and (iii) severity, which indicates whether the gaps between the income of the poor and the poverty line in a given population are equal. OOPs increased the prevalence, normalized gap, and severity of extreme poverty by 2.1 percentage points (pp), 0.7 pp (or 66 million international dollars), and 0.3 pp, respectively. The groups most affected by the extreme poverty severity increase were Faranah (0.7 pp), N'Zérékoré (0.4 pp), Kindia (0.4 pp), and Labé (0.4 pp)
as well as individuals aged ≥60 years (0.5 pp) and <
1 year (0.4 pp). OOPs had an equal or greater impact than other sectors that receive more funding such as education (prevalence: 0.4 pp
normalized gap: 0.1 pp
and severity: 0.0 pp). The concentration indexes of health financing with respect to the impact of OOPs on extreme poverty were -0.35 (prevalence), -0.34 (normalized gap), and -0.41 (severity), indicating a misalignment. Guinea urgently needs universal health coverage, which will necessitate improved allocative efficiency. Groups most affected by the extreme poverty severity increase could serve as priority groups.