Abstract
Background To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women's utilization of health care. Results Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p ≤ 0.001), facility-based delivery (Conc. Index = 0.069; p ≤ 0.001), and postnatal care (Conc. Index = 0.075; p ≤ 0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion Women enrollment in health insurance and improved household's financial status can improve key maternal health services utilization.
Highlights
To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low.e achievement of universal health care requires the provision and availability of an adequate financing system. is study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon
Our result shows that the Lorenz curve is further away from the line equality. e inequalities in household wealth level were more among women with health insurance who utilized adequate antenatal care (ANC), facility-based delivery, and postnatal care, as the areas between the curve and the line of inequality were maximal (Figures 2–4)
Based on the results from the Lorenz curve, we found a high degree of inequality, compared to a straight diagonal representing perfect equality—it shows the Lorenz curve is further away from the equality line. e inequalities in the household wealth level were more among women with health insurance who utilized adequate ANC, facility-based delivery, and postnatal care, as the areas between the curve
Summary
To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low.e achievement of universal health care requires the provision and availability of an adequate financing system. is study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. Despite improvements in maternal health across Africa, such improvements vary markedly between and within regions of the continent and countries. According to the World Health Organization (WHO), about 400 million people globally do not have access to basic quality health services, and 6% of the people living in low- and middle-income countries experience extreme poverty as a result of payment for health services [3]. For increased budgetary allocation and initiatives to have successful effects on health, including maternal health, improvements need to be made in health services provision to the public [1]
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