Structural Drivers of Inequities in Health

Ravindran, T.K. Sundari; Gaitonde, Rakhal; Srinivas, Prashanth Nuggehalli

doi:10.1007/978-981-10-5089-3_1

Cited by 8 publications

(10 citation statements)

References 13 publications

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“…In developing countries, mostly due to the lack of necessary information and skills for resource distribution, health resources are usually allocated in an unbalanced manner. 20 Based on the findings of the current study, burns-related beds were available in only one city, and the highest negative gap was shown to be for these beds, having the lowest rate per 10,000 population.…”

Section: Resultsmentioning

confidence: 74%

Assessing equity in the distribution of hospital beds: evidence from northern Iran

Ebrahimzadeh

Merati

Zafarghandi

et al. 2019

Proceedings of Singapore Healthcare

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Objective: To assess equity in the distribution of hospital beds in northern Iran. Methods: In this cross-sectional study, we investigated the degree of equity by using 2016 census data from 16 cities in Guilan province. The hospital beds include burns, intensive care unit, coronary care unit and neonatal intensive care unit beds. We analysed the general status and explored its distribution equity by using the Theil index. Findings: We found that Rezvanshahr and Masal had no hospital beds. The utilisation gap was positive only in Rasht, as capital of the province. Neonatal intensive care unit beds were only found in Rasht and Lahijan. Rasht was shown to have a positive gap in using burns, intensive care unit and coronary care unit beds, with a negative gap of 14.68 in coronary care unit beds. The other 15 cities did not have such hospital beds. For intensive care unit, coronary care unit and neonatal intensive care unit beds, nearly 8%, 2% and 14% of cities were deprived of being equipped with these hospital beds, respectively. The highest positive gap and the lowest negative gap were attributed to coronary care unit beds. In the province, there were 0.057 burns beds, 0.137 intensive care unit beds, 0.381 coronary care unit beds and 0.72 neonatal intensive care unit beds per 10,000 population (neonatal intensive care unit beds, per 1000 neonates). In 11 out of 16 cities, the number of coronary care unit beds per 10,000 population was higher than the provincial average. The highest inequality in distribution was shown to be for burns beds (0.8), neonatal intensive care unit beds (0.75), intensive care unit beds (0.55) and coronary care unit beds (0.21), respectively. Conclusion: This study revealed high inequalities in the distribution of hospital beds in northern Iran. The local and national policy-makers should design and implement a comprehensive monitoring and evaluation system for tracking and allocating healthcare resources, both qualitatively and quantitatively, which appears to be very necessary to increase the equity in access to healthcare services.

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Section: Resultsmentioning

confidence: 74%

Assessing equity in the distribution of hospital beds: evidence from northern Iran

Ebrahimzadeh

Merati

Zafarghandi

et al. 2019

Proceedings of Singapore Healthcare

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“…The schema (Table 1 ) also formed the basis for an evidence synthesis exercise (published elsewhere), and for soliciting themes for further research from multiple stakeholders [ 6 ]. We then used the same schema to organise the research agenda that emerged from the present exercise.…”

Section: Methodsmentioning

confidence: 99%

“…However, it is more important to generate evidence that unravels the factors and mechanisms that create, sustain and reinforce inequities. Nevertheless, the current evidence base on health inequities in India does not measure up to this task [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A diverse group of civil society actors has also engaged in health equity research mainly to inform their field-based interventions and advocacy. There has been limited interaction between the academia and civil society actors working on health equity, with the subsequent absence of a community of health equity researchers to develop a common agenda [ 6 ]. One consequence of such fragmentation is the large research gap on important issues related to inequities in health in the country.…”

Section: Introductionmentioning

confidence: 99%

“…One consequence of such fragmentation is the large research gap on important issues related to inequities in health in the country. Further, until recently, there have been no efforts to synthesise what is known and to develop a research agenda and priority areas of research on health inequities to inform national policy and programmatic action in India [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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A health equity research agenda for India: results of a consultative exercise

Ravindran

Seshadri²

2018

Health Res Policy Sys

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BackgroundThis paper describes the process and outcome of a consultative exercise undertaken to develop a medium-term agenda for the next decade, and to identify a short list of immediate priorities for health equity research in India. This exercise was undertaken over 2014–2017 as part of ‘Closing the Gap: Health Equity Research Initiative in India’, implemented by the Achutha Menon Centre for Health Science Studies, at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, in south India.MethodsWe adopted a five-step process for the agenda- and priority-setting exercise. The first step, which lasted for approximately 1 year, consisted of a synthesis of evidence on health inequities in India produced during 2000–2014 and identification of gaps. In the second step, we shared the evidence gaps identified and engaged with diverse stakeholders to develop the research agenda through face-to-face and online consultations. In step three, we consolidated the research agenda and identified continuing gaps. Key informant consultations by phone or email with experts in the areas where gaps were identified constituted the fourth step. In the fifth and final step, we organised an expert group consultation to review the agenda and identify immediate research priorities through a consensus process. Overall, approximately 220 persons participated in the entire process, and consisted of persons from diverse disciplines and sectors.ResultsThe research agenda and immediate priorities that emerged may be categorised into four themes, namely (1) descriptive research on the extent, nature and time trends in health inequities; (2) explanatory research on the pathways through which health inequities are created, and the political or policy environment that facilitates the process; (3) explanatory research that examines how health systems facilitate or mitigate inequities in healthcare; and (4) intervention research on initiatives that helped to mitigate health inequities, and examines the contributing factors.ConclusionThe strength of this research agenda is that it was developed through a broad-based consultation with stakeholders representing diverse disciplines, sectors and constituencies. The use of this agenda will help generate evidence that will facilitate India moving closer to the Sustainable Development Goal of leaving no one behind.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0367-0) contains supplementary material, which is available to authorized users.

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Does the presence of health insurance and health facilities improve healthcare utilisation for major morbidities among Indigenous communities and older widows: Evidence from the India Human Development Surveys I and II

George

Niyosenga

Mohanty

2021

Preprint

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In this paper, we examine whether access to treatment for major morbidity conditions is determined by the social class of the person who needs treatment. Secondly, we assess whether health insurance coverage and the presence of a PHC have any significant impact on the utilisation of health services, either public or private, for treatment and, more importantly, whether the presence of health insurance and PHC modify the treatment use behaviour for the two excluded communities of interest namely Indigenous communities and older widows using data from two rounds (2005 and 2012) of the nationally representative India Human Development Survey (IHDS). We estimated a multilevel mixed effects model with treatment for major morbidity as the outcome variable and social groups, older widows, the presence of a PHC and the survey wave as the main explanatory variables. The results confirmed access to treatment for major morbidity was affected by social class with Indigenous communities and older widows less likely to access treatment. Health insurance coverage did not have an effect that was large enough to induce a positive change in the likelihood of accessing treatment. The presence of a functional PHC increased the likelihood of treatment for all social groups except Indigenous communities. This is not surprising as Indigenous communities generally live in locations where the terrain is more challenging and decentralised healthcare up to the PHC might not work as effectively as it does for others. The social class to which one belongs has a significant impact on the ability of a person to access healthcare. Efforts to address inequity needs to take this into account and design interventions that are decentralised and planned with the involvement of local communities to be effective. Merely addressing one or two barriers to access in an isolated fashion will not lead to equitable access.

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Structural Drivers of Inequities in Health

Cited by 8 publications

References 13 publications

Assessing equity in the distribution of hospital beds: evidence from northern Iran

Assessing equity in the distribution of hospital beds: evidence from northern Iran

A health equity research agenda for India: results of a consultative exercise

Does the presence of health insurance and health facilities improve healthcare utilisation for major morbidities among Indigenous communities and older widows: Evidence from the India Human Development Surveys I and II

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