Abstract
BackgroundThis study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa.MethodsCluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data.FindingsLiving in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers.ConclusionsWithin a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized.
Highlights
Tred around “America First”, and health care reform to limit social medicine
Public health is a global issue; worldwide there were 57 million deaths in 2008, 63% of which were attributable to non-communicable diseases (NCDs) [1]
Despite the growing public awareness about NCDs and the consequences of related lifestyle choices, the incidence of NCDs continues to rise which creates a burden on global health care systems
Summary
Public health is a global issue; worldwide there were 57 million deaths in 2008, 63% of which were attributable to non-communicable diseases (NCDs) [1]. If individuals focus on themselves, the consideration of such community, national, and global costs are severely limited. With regards to health care reform and the debate around minimizing social medicine, it is important to emphasize that the people being targeted by - and most likely to benefit from -social medicine initiatives (eg, low socioeconomic status, the elderly) experience the greatest health disparities [5]. While limiting social medicine may result in short-term gains such as decreased health insurance premiums and tax dollar allotment, there is great potential for a longterm consequence of decreased community- and national-level overall health
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