Equity in health and healthcare in Malawi: analysis of trends

Abstract

BackgroundGrowing 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.ObjectiveThis 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.MethodsData from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.ResultsOverall, 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.ConclusionThe 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.

Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?

“…Indeed, this is further supported by the disproportionate use of private care 6 by richer quintiles in most countries, pointing to regressive distribution patterns (Gwatkin et al, 2004;Makinen et al, 2000). Zere, Moeti, Kirigia, Mwase, and Kataika, 2007 study of households in Malawi also investigates inequalities in health outcomes and utilization. For most indicators of health 7 , there was an increase in inequality between the poorest and richest quintiles between 1992 and 2004.…”

Socioeconomic Inequalities in the Use of Maternal Health Care Services in Nigeria

“…Access and responsive health care utilization remain relevant to maternal health promotion in many countries across the region. Inequality in resources such as household wealth and individual income was found to be factors inhibiting the extent of use of antenatal care, medically assisted delivery and to have a postnatal care (Zere, Moeti, Kirigia, Mwase, & Kataika, 2007).…”

Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

“…Similar to other definitions of equity, equity in revenue collection contains two aspects: vertical equity and horizontal equity. Vertical equity in revenue collection means that economically equal people must pay equally for health systems and horizontal equity means that unequal people must pay unequally for health system [7,8]. The aim of financial protection is constructing a revenue collection system, which people pay for health insurances according to their ability to pay [9].…”