Inequalities in public health care delivery in Zambia

Abstract

BackgroundAccess 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.MethodsThe 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.ResultsThere 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.ConclusionThe 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.

Use, access, and equity in health care services in São Paulo, Brazil

“…Garcia-Subirats et al 26 found similar results, that is, socioeconomic differences in resolution of health problems and initial health care-seeking in a large city in Brazil. Previous studies 4,28,35 showed that use of the private sector was more frequent among higher socioeconomic groups. Santos et al 36 found some inequalities in health care services favoring the population with private health plans in Brazil.…”

Equity Level of Health Insurance Ownership in Indonesia

“…These pro-rich characteristics can easily access combine both facilities, primary health care and hospital visit, which make wider inequity significantly. 27 Reflecting this result, young individuals with sufficient financial conditions have to be encouraged to be participants of Indonesia NHI than to purchase private health insurance. In the early stages, BPJS Kesehatan should appeal to those characteristics at manager level and higher to be encouraged to be NHI program participants.…”

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“…The production, recruitment and retention of human resources play a critical role in the success of the decentralization. In the current study in Zambia, staff was not well oriented and change management was not actively pursued prior to realignmentespecially pertaining to role allocation, responsibilities and management as has been recommended (Central Statistical Office Zambia;2014). Unfortunately these country experiences have not been widely shared (Bossert et al, 2003).…”

“…As the health sector in Zambia thrives to deepen decentralization including transfer pf responsibility of service provision to the Ministry of Local Government, there is need for adequate preparation focusing on systems and structures as well as the human resource factor including change management approach. This human resource software requires a paradigm shift with need to target the WHO benchmarks on the basic minimum 23/10000 health workers per population (right now we have less than 8) to attain UHC (Central Statistical Office Zambia;2014) to enable the requisite continuum of interventions across the district community divide to ensure the community is fully engaged and empowered. The dysfunctional status of the community health strategy in the Zambia setting is a major cause of disjointedness of the continuum of care between community and health facility.…”

“…The issue of long distances to health facilities is being aggressively addressed by government through the construction of clinics throughout the country all at an advanced stage plus the extensive road networks. Little has been done to systematically address the human resource conundrums where the staff are available and unemployed but cannot be recruited or incentivised for deployment in hard to reach areas where dire shortages exist because of fiscal budgetary issues (Ferrinho et al, 2011;Phiri et al, 2014).…”