An equity analysis of utilization of health services in Afghanistan using a national household survey.

Christine Kim,Khwaja Mir Ahad Saeed,Wu Zeng,Ahmad Shah Salehi

doi:10.1186/s12889-016-3894-z

Abstract

BackgroundAfghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood.MethodsWe analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence).ResultsAmong households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services.ConclusionsThe large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector’s role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches in health should be prioritized to promote more inclusive health system reforms.

Highlights

Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood
The first Universal Health Coverage (UHC) day was held in December 2014, recognizing the right for all people to access quality, essential health services when needed without financial hardship [1]
Regarding inequality and inequity of utilization of health services, inequality is defined as any differences in health utilization between different population groups, while inequity is the part of inequality that is considered unjustified, where factors correlated with health are considered unfair due to the inability to access an equal amount of care based on need regardless of socioeconomic status [21]

Summary

Introduction

Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. The Government of Afghanistan began implementing the Basic Package of Health Services (BPHS) in 2003 to provide a standardized package of basic primary health care services across the country [4]. This was complemented by the Essential Package of Hospital Services (EPHS), introduced in 2005, to increase referrals and access to hospital services [5]. Only 45.7% of children aged 12–23 months are fully vaccinated, 55% of children under five years suffer from stunting, and only 48.1% of women deliver in a health facility [9, 12]

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Conclusion