Equity in the use of public services for mother and newborn child health care in Pakistan: a utilization incidence analysis

Abstract

BackgroundPoor maternal and infant health indicators are mostly concentrated among low income households in Pakistan and health care expenditures – especially on medical emergencies – are the most common income shocks experienced by the poor. Public investments in health are therefore considered as pro-poor interventions by the government of Pakistan. This study employs nationally representative household data for Pakistan for 2007–08 and 2010–11 to investigate whether benefits from publicly financed services on Mother and Newborn Child Health (MNCH) are effectively captured by the poor in terms of service utilization.MethodsThe study conducts a Utilization Incidence Analysis of the use of public health services for MNCH in Pakistan. For this purpose, the utilization shares of households, ranked by economic status, are computed. The concentration curves are plotted and their dominance is tested against an equal distribution and Lorenz curves to determine whether the distribution is pro-poor and progressive.ResultsAlthough the shares of bottom income groups in the utilization of most services for MNCH have increased between 2007 and 2011, the utilization of some services such as post-natal consultation; institutional maternal delivery; and Tetanus Toxoid injections for pregnant women remains pro-rich in 2011. The utilization of pre-natal consultation, especially through lady health workers and visitors; the use of Family Panning Units; and immunization services is somewhat evenly distributed. The use of Basic Health Units (BHUs) is found to be pro-poor. The provincial analysis reveals that the province of Baluchistan depicts an unusually high level of inequity in the distribution of utilization benefits from almost all public health services. Finally, in terms of progressivity, public spending on all health services analyzed in the study is found to be progressive at the national level implying that investment in MNCH has the potential to redistribute income from rich to the poor.ConclusionTo target the poor effectively, the study recommends expanding the network of BHUs as well as basic reproductive and child health care services. The outreach of health facilities in Baluchistan need to be expanded while targeting the poor effectively by mitigating various access costs that prevent them from using public health services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0405-x) contains supplementary material, which is available to authorized users.

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

“…Community–based approaches can reach those furthest from health facilities and can rapidly expand population coverage of key interventions, so these findings are not surprising. These findings stand in stark contrast to the commonly observed finding that utilization of primary health care facilities is inequitable because those in the lower income quintiles are less likely to obtain services there [ 25 , 26 ]. This evidence together with the lack of evidence that investments in facilities alone can improve population health in resource–constrained settings [ 27 , 28 ] provide additional support for the importance of investing in CBPHC for improving MNCH.…”

Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia

“…The utilization of all the studied childhood immunizations for children aged 12–23 months tended to be equitably distributed between the poorest and better-off. This is in line with findings from other studies in Ethiopia [4] and Pakistan [33]. In contrast, the Ethiopian Demographic and Health Survey 2016 [13], as well as reports from other low-and middle-income countries [21, 36], have shown immunization coverage in favor of the better-off.…”

“…Similar results have also been reported from other sub-Sharan African countries, such as Benin [27], Burkina Faso [28], and Nigeria [29], and other low- and middle-income countries, such as Philippines [30], Afghanistan [31], and Bangladesh [32]. In contrast, studies in Pakistan [33] and Myanmar [34] found equitable distribution in the utilization of four or more antenatal care visits.…”

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 5. equity effects for neonates and children

“…Community–based approaches can reach those furthest from health facilities and can rapidly expand population coverage of key interventions, so these findings are not surprising. These findings stand in stark contrast to the commonly observed finding that utilization of primary health care facilities is inequitable because those in the lower income quintiles are less likely to obtain services there [ 52 , 53 ]. To our knowledge, this is the first comprehensive review in the peer–reviewed literature summarizing the equity effects of CBPHC in improving child health.…”