Abstract
BackgroundDespite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices.MethodsData on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index).ResultsThe maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed.ConclusionUtilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.
Highlights
Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country
Data source The present study was part of an evaluation of the large project entitled “Optimizing the Health Extension Program” (OHEP) that aimed at improving services utilization of the integrated community case management of childhood illnesses (ICCM) and the community-based newborn care (CBNC)
Thirty-seven percent of the women were in the age group of fewer than 20 years and 38% were in the age group of 20–34 years
Summary
Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. An analysis in Sub-Saharan Africa (SSA) showed that countries with an improved equitable utilization in maternal and child health services had demonstrated a continued reduction in maternal and child mortality, though inequities in utilization still persisted [3]. These patterns in the utilization of maternal, neonatal, and child health services are found in the Ethiopian context [4]. The poor suffer higher rates of morbidity and mortality than the better-off and often use health services less despite higher needs [8] These inequities are serious public health concerns with social and economic implications [6,7,8]. Health equity became central in the post-2015 Sustainable Development Goals (SDGs) globally [9] and it is a priority for Ethiopia [10]
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