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Equity in health and healthcare in Malawi: analysis of trends.

Zere E, Moeti M, Kirigia J, Mwase T, Kataika E - BMC Public Health (2007)

Bottom Line: It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies.There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.

View Article: PubMed Central - HTML - PubMed

Affiliation: World Health Organization, Lilongwe, Malawi. zeyob@yahoo.com

ABSTRACT

Background: Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.

Objective: This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.

Methods: Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.

Results: Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.

Conclusion: The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.

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Related in: MedlinePlus

Concentration curves for selected health service use indicators in children: Immunization coverage and ARI treatment. (a) Immunization: basic full coverage. (b) ARI treatment. (c) ARI treatment in Public facility.
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Figure 4: Concentration curves for selected health service use indicators in children: Immunization coverage and ARI treatment. (a) Immunization: basic full coverage. (b) ARI treatment. (c) ARI treatment in Public facility.

Mentions: Figure 4(a and b) indicates that no improvements were seen in equity in the use of child health services related to immunization coverage and ARI treatment during the period under consideration. With respect to immunization coverage, the pro-rich inequity has increased. In 1992, there was no inequity in ARI treatment as observed from Figure 4(b) where the concentration curve is very close to the line of equality. However, caution should be exercised here. As it has been discussed in Section 5.1, pro-rich inequity is observed in the prevalence of ARI, that is, there is a high concentration of the ARI burden among children from the poorest households. If equity is to prevail, the principle of vertical equity (unequal treatment for unequal need) demands that those with greater need should receive more of the treatment. However, what is observed in the current case is that there is equal treatment for unequal need and clearly violates the requirements of vertical equity. Hence, there is inequity, as the poor who have a greater need for treatment as compared to the non-poor are not getting the treatment according to their need. Furthermore, Figure 4(b) shows that the concentration curve for 2000 has deviated from the line of equality significantly. This implies that use of public sector facilities has become more inequitable – the non-poor using the public sector healthcare resources more than the poor and out of proportion to their need. Other indicators of use of child health services include interventions related to the treatment of diarrhoea. Figure 5 below depicts this information.


Equity in health and healthcare in Malawi: analysis of trends.

Zere E, Moeti M, Kirigia J, Mwase T, Kataika E - BMC Public Health (2007)

Concentration curves for selected health service use indicators in children: Immunization coverage and ARI treatment. (a) Immunization: basic full coverage. (b) ARI treatment. (c) ARI treatment in Public facility.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1884146&req=5

Figure 4: Concentration curves for selected health service use indicators in children: Immunization coverage and ARI treatment. (a) Immunization: basic full coverage. (b) ARI treatment. (c) ARI treatment in Public facility.
Mentions: Figure 4(a and b) indicates that no improvements were seen in equity in the use of child health services related to immunization coverage and ARI treatment during the period under consideration. With respect to immunization coverage, the pro-rich inequity has increased. In 1992, there was no inequity in ARI treatment as observed from Figure 4(b) where the concentration curve is very close to the line of equality. However, caution should be exercised here. As it has been discussed in Section 5.1, pro-rich inequity is observed in the prevalence of ARI, that is, there is a high concentration of the ARI burden among children from the poorest households. If equity is to prevail, the principle of vertical equity (unequal treatment for unequal need) demands that those with greater need should receive more of the treatment. However, what is observed in the current case is that there is equal treatment for unequal need and clearly violates the requirements of vertical equity. Hence, there is inequity, as the poor who have a greater need for treatment as compared to the non-poor are not getting the treatment according to their need. Furthermore, Figure 4(b) shows that the concentration curve for 2000 has deviated from the line of equality significantly. This implies that use of public sector facilities has become more inequitable – the non-poor using the public sector healthcare resources more than the poor and out of proportion to their need. Other indicators of use of child health services include interventions related to the treatment of diarrhoea. Figure 5 below depicts this information.

Bottom Line: It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies.There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.

View Article: PubMed Central - HTML - PubMed

Affiliation: World Health Organization, Lilongwe, Malawi. zeyob@yahoo.com

ABSTRACT

Background: Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.

Objective: This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.

Methods: Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.

Results: Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.

Conclusion: The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.

Show MeSH
Related in: MedlinePlus