Sunday 16 December 2012

POVERTY: Kenya: Analyzing the equity of public primary care provision in Kenya

   Analyzing the equity of public primary care provision in Kenya: variation in facility characteristics by local poverty level Toda M, Opwora A, Waweru E, Noor A, Edwards T, Fegan G, Molyneux C, Goodman C 
International Journal for Equity in Health 2012, 11:75 (13 December 2012)
[Abstract] [Provisional PDF]
 

Introduction

Equitable access to health care is a key health systems goal, and is a particular concern in low-income countries. In Kenya, public facilities are an important resource for the poor, but little is known on the equity of service provision. This paper assesses whether poorer areas have poorer health services by investigating associations between public facility characteristics and the poverty level of the area in which the facility is located.

Methods

Data on facility characteristics were collected from a nationally representative sample of public health centers and dispensaries across all 8 provinces in Kenya. A two-stage cluster randomized sampling process was used to select facilities. Univariate associations between facility characteristics and socioeconomic status (SES) of the area in which the facility was located were assessed using chi-squared tests, equity ratios and concentration indices. Indirectly standardized concentration indices were used to assess the influence of SES on facility inputs and service availability while controlling for facility type, province, and remoteness.

Results

For most indicators, we found no indication of variation by SES. The clear exceptions were electricity and laboratory services which showed evidence of pro-rich inequalities, with equity ratios of 3.16 and 3.43, concentration indices of 0.09 (p<0 .01=".01" 0.05="0.05" 0.07="0.07" 90="90" also="also" and="and" availability="availability" close="close" concentration="concentration" delivery="delivery" div="div" does="does" drugs="drugs" evidence="evidence" example="example" facilities="facilities" family="family" for="for" half="half" high="high" imply="imply" indications="indications" indicators="indicators" indirectly="indirectly" inequalities="inequalities" inequality="inequality" inputs="inputs" invariably="invariably" lack="lack" not="not" of="of" offered="offered" or="or" other="other" outreach.="outreach." p="0.01)." planning="planning" pro-rich="pro-rich" qualified="qualified" ratios="ratios" services="services" some="some" staff.="staff." standardized="standardized" supply="supply" that="that" the="the" there="there" to="to" under="under" was="was" water="water" were="were" while="while">

Conclusions

The paper shows how local area poverty data can be combined with national health facility surveys, providing a tool for policy makers to assess the equity of input and service availability. There was little evidence of inequalities for most inputs and services, with the clear exceptions of electricity and laboratory services. However, efforts are required to improve the availability of key inputs and services across public facilities in all areas, regardless of SES.
You currently receive International Journal for Equity in Health article alerts whenever new articles are published
To change the email format or frequency, to update your email address or to stop receiving these alerts, visit http://www.equityhealthj.com/my/preferences.

For help or more information, contact us at info@biomedcentral.com
 

No comments:

Post a Comment