Inequalities in public health care delivery in Zambia

 

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dc.contributor.author Phiri, Jane
dc.contributor.author Ataguba, John E
dc.date.accessioned 2015-02-16T19:05:05Z
dc.date.available 2015-02-16T19:05:05Z
dc.date.issued 2014-03-19
dc.identifier.citation Phiri, J., & Ataguba, J. E. (2014). Inequalities in public health care delivery in Zambia. International journal for equity in health, 13(1), 24. en_ZA
dc.identifier.issn 1475-9276
dc.identifier.uri http://hdl.handle.net/11427/12487
dc.identifier.uri http://dx.doi.org/10.1186/1475-9276-13-24
dc.description.abstract Background: Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods: The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results: There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are −0.28 and −0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at −0.23 and −0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant. Conclusion: The results of the paper point to areas of focus in ensuring equitable access to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia. en_ZA
dc.language eng en_ZA
dc.publisher BioMed Central en_ZA
dc.rights Creative Commons Attribution 4.0 International (CC BY 4.0) *
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en_ZA
dc.source International Journal for Equity in Health en_ZA
dc.source.uri http://www.equityhealthj.com
dc.subject.other Health inequality en_ZA
dc.subject.other Health inequity en_ZA
dc.subject.other Public health care en_ZA
dc.subject.other Zambia en_ZA
dc.title Inequalities in public health care delivery in Zambia en_ZA
dc.type Journal Article en_ZA
dc.date.updated 2015-01-15T17:54:05Z
dc.language.rfc3066 en
dc.rights.holder Phiri and Ataguba; licensee BioMed Central Ltd.
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Health Economics Unit en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Phiri, J., & Ataguba, J. E. (2014). Inequalities in public health care delivery in Zambia. <i>International Journal for Equity in Health</i>, http://hdl.handle.net/11427/12487 en_ZA
dc.identifier.chicagocitation Phiri, Jane, and John E Ataguba "Inequalities in public health care delivery in Zambia." <i>International Journal for Equity in Health</i> (2014) http://hdl.handle.net/11427/12487 en_ZA
dc.identifier.vancouvercitation Phiri J, Ataguba JE. Inequalities in public health care delivery in Zambia. International Journal for Equity in Health. 2014; http://hdl.handle.net/11427/12487. en_ZA
dc.identifier.ris TY - Journal Article AU - Phiri, Jane AU - Ataguba, John E AB - Background: Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods: The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results: There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are −0.28 and −0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at −0.23 and −0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant. Conclusion: The results of the paper point to areas of focus in ensuring equitable access to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia. DA - 2014-03-19 DB - OpenUCT DO - 10.1186/1475-9276-13-24 DP - University of Cape Town J1 - International Journal for Equity in Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 SM - 1475-9276 T1 - Inequalities in public health care delivery in Zambia TI - Inequalities in public health care delivery in Zambia UR - http://hdl.handle.net/11427/12487 ER - en_ZA


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