Socioeconomic inequalities and determinants of health care utilization in Botswana: a decomposition analysis

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In Botswana, healthcare services are more accessible to the more affluent, while healthcare benefits for the poor remain limited. The main aim of this study was to assess socioeconomic inequalities in health care utilization in Botswana. Using a multistage cross sectional design, 1178 male and female respondents aged 15 years and above were interviewed across three cities and towns, 15 urban villages and 15 rural villages. Health care utilization was measured using four indicators: health care needed, health care received, seeking health care for NCDs and use of health facilities. Multivariate analysis was performed using SPSS version 25, while decomposition of inequalities was carried out using ADePT (version 6). All comparisons were considered statistically significant at p < 0.05. Concentration indices show that poor people did not seek health care when sick (CI = −0.0084), did not receive health care when they needed it (CI = –0.0175) and often used public health facilities (CI = –0.0531). On the other hand, seeking health care for NCDs was slightly concentrated among the non-poor (CI = 0.0465). All observed inequalities were small and overlapped with the line of inequality except for receiving health care in public health facilities. Education and wealth status were key contributing factors to inequalities for all health care utilization indicators. Findings from this study indicate the need for improvements in education and economic well-being of poor people in Botswana in order to close the inequality gap for health care utilization.