Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care

Memirie, Solomon Tessema; Verguet, Stéphane; Norheim, Ole Frithjof; Levin, Carol; Johansson, Kjell Arne

doi:10.1186/s12913-016-1296-7

Cited by 63 publications

(83 citation statements)

References 21 publications

(20 reference statements)

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“…Despite the binary nature of the dependent variables, a linear probability model is used. Available literatures suggest decomposition of C shows no significant differences whenever linear and non-linear models are used [30, 31]. …”

Section: Methodsmentioning

confidence: 99%

Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?

Paredes

2016

Int J Equity Health

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BackgroundThe Philippines failed to achieve its Millennium Development Goal (MDG) commitment to reduce maternal deaths by three quarters. This, together with the recently launched Sustainable Development Goals (SDGs), reinforces the need for the country to keep up in improving reach of maternal and child health (MCH) services. Inequitable use of health services is a risk factor for the differences in health outcomes across socio-economic groups. This study aims to explore the extent of inequities in the use of MCH services in the Philippines after pro-poor national health policy reforms.MethodsThis paper uses data from the 2008 and 2013 Demographic and Health Survey (DHS) in the Philippines. Socio-economic inequality in MCH services use was measured using the concentration index. The concentration index was also decomposed in order to examine the contribution of different factors to the inequalities in the use of MCH services.ResultsIn absolute figures, women who delivered in facilities increased from 2008 to 2013. Little change was noted for women who received complete antenatal care and caesarean births. Facility deliveries remain pro-rich although a pro-poor shift was noted. Women who received complete antenatal care services also remain concentrated to the rich. Further, there is a highly pro-rich inequality in caesarean deliveries which did not change much from 2008 to 2013. Household income remains as the most important contributor to the resulting inequalities in health services use, followed by maternal education. For complete antenatal care use and deliveries in government facilities, regional differences also showed to have important contribution.ConclusionThe findings suggest inequality in the use of MCH services had limited pro-poor improvements. Household income remains to be the major driver of inequities in MCH services use in the Philippines. This is despite the recent national government-led subsidy for the health insurance of the poor. The highly pro-rich caesarean deliveries may also warrant the need for future studies to determine the prevalence of medically unindicated caesarean births among high-income women.Trial registrationNot applicable.

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Section: Methodsmentioning

confidence: 99%

Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?

Paredes

2016

Int J Equity Health

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“…Similarly, Memirie et al . () observed persistent wealth‐related inequality in Ethiopia. Utilization of primary care facilities for selected maternal and child health interventions showed pro‐poor improvement over the period 2005–11.…”

Section: Empirical Literaturementioning

confidence: 98%

Inequity in Maternal and Child Health Care Utilization in Nigeria

Nghargbu¹,

Olaniyan²

2017

African Development Review

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The study assesses the degree and patterns of horizontal inequity in maternal and child health care utilization in Nigeria. Horizontal inequity was estimated using concentration curves and a standardized concentration index, which was decomposed into need and non-need variables to capture the major drivers of inequity in utilization. Maternal and child health care utilization was measured by antenatal visits, skilled delivery and immunization utilization. Four rounds of Nigerian Demographic and Health Survey (DHS) data (1999, 2003, 2008, 2013) were used. The results show a positive horizontal inequity index from 1999 to 2013; which indicates that there is pro-rich inequity in utilization of antenatal, skilled delivery and immunization, respectively. The study concludes that there is higher and increasing inequity in maternal health care while inequity in utilization of child health care decreased over time with wealth status and education as the major non-need drivers of inequity in utilization. Interventions to enhance women's wealth status and education could significantly improve equity in skilled delivery and antenatal care utilization. Hence wealth creation, women empowerment and education should be given more attention to improve the deteriorating equity in maternal health care utilization.

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“…Studies have reported demand and supply-side barriers to accessing and utilizing facility-based interventions. Demand-side determinants of access and use of MCH services in different LMICs are reported to be in uenced by individual, household, community and other contextual factors; with a variation across and within cultures [7][8][9][10]. Supply-side factors are attributed to inadequate number of health workers, reduced capacity and poor motivation of available staff , as well as other factors affecting their retention [6,11].…”

Section: Introductionmentioning

confidence: 99%

“If you are on duty, you may be afraid to come out to attend to a person”: Fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.

Etiaba

Manzano

Agbawodikeizu

et al. 2020

Preprint

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Background Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology. Results The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff. Conclusion Health facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.

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Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care

Cited by 63 publications

References 21 publications

Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?

Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?

Inequity in Maternal and Child Health Care Utilization in Nigeria

“If you are on duty, you may be afraid to come out to attend to a person”: Fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.

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