Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey

Stefania Ilinca,Laura Di Giorgio,Paola Salari,Jane Chuma

doi:10.1186/s12939-019-1106-z

Abstract

BackgroundKenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch.MethodsWe use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis.ResultsWe find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups.ConclusionsThrough its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care.

Highlights

Kenya is experiencing persistently high levels of inequity in health and access to care services
Health care utilization in Kenya increases with socioeconomic status
Both preventive and promotive health services and inpatient services are more unequally distributed than outpatient care services, but we find no evidence of a marked difference in inequality in care use between the former two

Summary

Introduction

Kenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. A key priority in this context is to address persistent socio-economic inequities in access to care by ensuring health services are available to all those who need them and that no undue and prohibitive financial burden is placed on those seeking care [2, 3]. Evidence from country specific studies converges on the conclusion, that impoverished or lower socio-economic status individuals face larger barriers to accessing needed care services [16,17,18]

Results

Discussion

Conclusion