Abstract
BackgroundKnowledge of health care utilization is important in low-and middle-income countries where inequalities in the burden of diseases and access to primary health care exist. Limited evidence exists on health seeking and utilization in the informal settlements in Kenya. This study assessed the patterns and predictors of private and public health care utilization in an urban informal settlement in Kenya.MethodsThis study used data from the Lown scholars study conducted between June and July 2018. A total of 300 households were randomly selected and data collected from 364 household members who reported having sought care for an illness in the 12 months preceding the study. Data were collected on health-seeking behaviour and explanatory variables (predisposing, enabling, and need factors). Health care utilization patterns were described using proportions. Predictors of private or public health care use were identified using multinomial logistic regression with the reference group being other providers.ResultsMajority of the participants used private (47%) and public facilities (33%) with 20% using other providers including local pharmacies/drug shops and traditional healers. In the model comparing public facilities vs other facilities, members who were satisfied with the quality of health care (vs not satisfied) were less likely to use public facilities (adjusted relative risk ratio (aRRR) 0.29; CI 0.11–0.76) while members who reported an acute infection (vs no acute infection) were more likely to use public facilities (aRRR 2.31; 95% CI 1.13–4.99) compared to other facilities. In the second model comparing private facilities to other facilities, having health insurance coverage (aRRR 2.95; 95% CI 1.53–5.69), satisfaction with cost of care (aRRR 2.08; CI 1.00–4.36), and having an acute infection (aRRR 2.97; 95% CI 1.50–5.86) were significantly associated with private facility use compared to other facilities.ConclusionsThe majority of urban informal settlement dwellers seek care from private health facilities. As Kenya commits to achieving universal health coverage, interventions that improve health care access in informal and low-resource settlements are needed and should be modelled around enabling and need factors, particularly health care financing and quality of health care.
Highlights
Knowledge of health care utilization is important in low-and middle-income countries where inequalities in the burden of diseases and access to primary health care exist
Knowledge of health care utilization is crucial in low-and middle-income countries (LMICs) where inequalities in the burden of disease and access to primary health care exist and may be attributable to the unrealised health gains observed in these settings [2, 3]
Universal health coverage in LMICs has largely focused on the public health care sector as it has been argued that public health service provision is the best guarantee for equitable health care access and improved health outcomes for entire populations
Summary
Knowledge of health care utilization is important in low-and middle-income countries where inequalities in the burden of diseases and access to primary health care exist. Understanding patterns of health care utilization and knowledge of associated factors are important in improving health service delivery and ensuring equitable access to health services [1]. Knowledge of health care utilization is crucial in low-and middle-income countries (LMICs) where inequalities in the burden of disease and access to primary health care exist and may be attributable to the unrealised health gains observed in these settings [2, 3]. As more evidence becomes available on the burden of disease in informal settlements, it is important to assess the patterns of health care utilization and influencing factors. Universal health coverage in LMICs has largely focused on the public health care sector as it has been argued that public health service provision is the best guarantee for equitable health care access and improved health outcomes for entire populations
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