Abstract
BackgroundPoor and marginalized segments of society often display the worst health status due to limited access to health enhancing interventions. It follows that in order to enhance the health status of entire populations, inequities in access to health care services need to be addressed as an inherent element of any effort targeting Universal Health Coverage. In line with this observation and the need to generate evidence on the equity status quo in sub-Saharan Africa, we assessed the magnitude of the inequities and their determinants in coverage of maternal health services in Burkina Faso.MethodsWe assessed coverage for three basic maternal care services (at least four antenatal care visits, facility-based delivery, and at least one postnatal care visit) using data from a cross-sectional household survey including a total of 6655 mostly rural, poor women who had completed a pregnancy in the 24 months prior to the survey date. We assessed equity along the dimensions of household wealth, distance to the health facility, and literacy using both simple comparative measures and concentration indices. We also ran hierarchical random effects regression to confirm the presence or absence of inequities due to household wealth, distance, and literacy, while controlling for potential confounders.ResultsCoverage of facility based delivery was high (89%), but suboptimal for at least four antenatal care visits (44%) and one postnatal care visit (53%). We detected inequities along the dimensions of household wealth, literacy and distance. Service coverage was higher among the least poor, those who were literate, and those living closer to a health facility. We detected a significant positive association between household wealth and all outcome variables, and a positive association between literacy and facility-based delivery. We detected a negative association between living farther away from the catchment facility and all outcome variables.ConclusionExisting inequities in maternal health services in Burkina Faso are likely going to jeopardize the achievement of Universal Health Coverage. It is important that policy makers continue to strengthen and monitor the implementation of strategies that promote proportionate universalism and forge multi-sectoral approach in dealing with social determinants of inequities in maternal health services coverage.
Highlights
Poor and marginalized segments of society often display the worst health status due to limited access to health enhancing interventions
We investigated inequities in maternal health service coverage along three equity dimensions: i) household wealth; ii) woman’s education; and iii) distance to catchment primary health facility
This ranged from a low of 21% in Yako in Nord region to a high of 66% in Tenkodogo in Centre-Est region for ANC4+; from a low of 64% in Gaoua in Sud-Ouest region to a high of 100% in Ziniare in Plateau region for facility
Summary
Poor and marginalized segments of society often display the worst health status due to limited access to health enhancing interventions. It follows that in order to enhance the health status of entire populations, inequities in access to health care services need to be addressed as an inherent element of any effort targeting Universal Health Coverage. The United Nations Committee on information and accountability for Women’s and Children’s Health suggests that indicators for reproductive, maternal and child health should be disaggregated using social stratifiers, such as wealth quintiles, gender, residence (urban/ rural), and education, among others. This is considered essential to adequate monitoring of equitable progress towards achieving the SDG health indicator targets at all levels, from global to regional to country [2, 11]
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