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Pro-poor health policy

Meliyanni Johar, Prastuti Soewondo, Retno Pujisubekti, Harsa Kunthara Satrio, Ardi Adji
While disparities in access to health services by different economic groups have been well documented, much less is known about the factors that are contributing to these disparities. In this paper, we take the case of Indonesia, which has the six-worst wealth inequality in the world. The data is derived from the national socio-economic survey from 2011 to 2016, giving a total sample of over 5.5 million individuals. We find that only access to outpatient care at public primary health facilities is pro-poor, whilst access to other types of health care is pro-rich...
July 29, 2018: Social Science & Medicine
Mostafa Amini Rarani, Mehdi Nosratabadi, Maryam Moeeni
BACKGROUND: Early childhood development is influenced by family socioeconomic status in such a way that socioeconomic deprivation might be accompanied with adverse outcomes in early development of a child. This study aimed to assess early childhood development based on average and also based on the distribution of socioeconomic inequality in Iran and its provinces. METHODS: Using data from provincially representative Multiple Indicator Demographic and Health Survey (2010), we developed a suitable latent class approach to construct a proxy of socioeconomic status...
August 3, 2018: International Journal of Health Planning and Management
Mohammad Hajizadeh, Min Hu, Amy Bombay, Yukiko Asada
Using three nationally representative Aboriginal Peoples Surveys (2001, 2006 and 2012, n = 68,040), we examined income-related inequalities in self-perceived poor/fair general health status among Indigenous adults (18+) living off-reserve in Canada. We used the relative and absolute concentration indices (RC and AC, respectively) to quantify income-related inequalities in health for men and women, within the three Indigenous populations (First Nations, Métis, and Inuit), and in different geographic regions...
July 3, 2018: Health Policy
Peter C Rockers, Richard O Laing, Veronika J Wirtz
Introduction: Wealth-based inequity in access to medicines is an impediment to achieving universal health coverage in many low-income and middle-income countries. We explored the relationship between household wealth and access to medicines for non-communicable diseases (NCDs) in Kenya. Methods: We administered a cross-sectional survey to a sample of patients prescribed medicines for hypertension, diabetes or asthma. Data were collected on medicines available in the home, including the location and cost of purchase...
2018: BMJ Global Health
Tanvir M Huda, Alison Hayes, Michael J Dibley
Background: The utilization of maternal health care services has increased in many developing countries, but persistent wealth-related inequalities in use of maternal services remained an important public health issue. The paper examined the horizontal inequities and identified the key social determinants that can potentially explain such wealth-related inequalities in use of facility delivery services. Methods: The countries studied are Bangladesh, Pakistan and Nepal...
June 2018: Journal of Global Health
Athanase Nzokirishaka, Imose Itua
Background: High unmet need for family planning (32.4%) characterized Burundi in 2010. However, there has not been any study examining the relationship between unmet need and associated factors in Burundi. The present study aims at determining the demographic, socioeconomic and other factors underlying the unmet need for contraception among married women aged 15-49 in Burundi. Methods: This study used data from the 2010 Burundi Demographic and Health Survey. Total unmet need, unmet need for spacing and for limiting were used as outcomes and demographic, socioeconomic and other factors as independent variables...
2018: Contraception and Reproductive Medicine
Shahab Rezaeian, Mohammad Hajizadeh, Satar Rezaei, Sina Ahmadi, Ali Kazemi Karyani, Yahya Salimi
BACKGROUND: Equity in healthcare utilization is a major health policy goal in all healthcare systems. This study aimed to examine socioeconomic inequalities in public healthcare utilization in Kermanshah City, western Iran. STUDY DESIGN: A cross-sectional study. METHODS: Using convenience sampling method, 2040 adult aged 18-65 yr were enrolled from Kermanshah City in 2017. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, socioeconomic status, behavioral factors, and utilization of public healthcare services (inpatient and outpatient care) over the period between from May to Aug 2017...
May 14, 2018: Journal of Research in Health Sciences
William Joe, Jessica M Perkins, Saroj Kumar, Sunil Rajpal, S V Subramanian
To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality...
June 1, 2018: Health Policy and Planning
Franco Sassi, Annalisa Belloni, Andrew J Mirelman, Marc Suhrcke, Alastair Thomas, Nisreen Salti, Sukumar Vellakkal, Chonlathan Visaruthvong, Barry M Popkin, Rachel Nugent
Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households...
May 19, 2018: Lancet
Juan Antonio Córdoba-Doña, Antonio Escolar-Pujolar, Miguel San Sebastián, Per E Gustafsson
Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011-2012 (crisis), using a composite income index as socioeconomic status (SES) indicator...
2018: PloS One
Xueshan Sun, Hao Zhang, Xiaoqian Hu, Shuyan Gu, Xuemei Zhen, Yuxuan Gu, Minzhuo Huang, Jingming Wei, Hengjin Dong
BACKGROUND: Equity is the core of primary care. The issue of equity in health has become urgent, and China has attached increasing attention to it. With rapid economic development and great changes in medical insurance policy, the pattern of equity in health has changed tremendously. The reform of healthcare in Zhejiang Province is at the forefront in China, and studies on Zhejiang Province are of great significance to the entire country. This paper aimed to measure health equity from the perspectives of health needs and health-seeking behavior and to provide suggestions for the next policy formulations, with respect to timeliness...
March 22, 2018: International Journal for Equity in Health
Shamsul Arifeen Khan Mamun, Rasheda Khanam, Mohammad Mafizur Rahman
BACKGROUND: The Government of Bangladesh has a National Healthcare Strategy 2012-2032 that reiterates a goal to achieve universal health coverage (UHC) by the year 2032. To achieve the goal, the government has set up a strategy to reduce the share of out-of-pocket (OOP) expenditure from the current 64% of the total household healthcare costs to 32% at the national level. As the majority of the people live in the rural areas, and the rural people are generally poor, the success of the strategy relies predominantly on any type of pro-poor healthcare policy and strategy...
April 2018: Applied Health Economics and Health Policy
Satar Rezaei, Mohammad Hajizadeh, Masoud Khosravipour, Farid Khosravi, Shahab Rezaeian
BACKGROUND: Socioeconomic status (SES) is an important determinant of health-related quality of life (HRQoL). We aimed to quantify socioeconomic-related inequality in poor-HRQoL among adults in Kermanshah, western Iran. STUDY DESIGN: A cross-sectional study. METHODS: Overall, 1730 adults (18-65 yr) were selected using convenience sampling from Kermanshah, Iran. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, SES, lifestyle factors and HRQoL of participants over the period between May and Aug 2017...
January 27, 2018: Journal of Research in Health Sciences
Adrianna Murphy, Benjamin Palafox, Owen O'Donnell, David Stuckler, Pablo Perel, Khalid F AlHabib, Alvaro Avezum, Xiulin Bai, Jephat Chifamba, Clara K Chow, Daniel J Corsi, Gilles R Dagenais, Antonio L Dans, Rafael Diaz, Ayse N Erbakan, Noorhassim Ismail, Romaina Iqbal, Roya Kelishadi, Rasha Khatib, Fernando Lanas, Scott A Lear, Wei Li, Jia Liu, Patricio Lopez-Jaramillo, Viswanathan Mohan, Nahed Monsef, Prem K Mony, Thandi Puoane, Sumathy Rangarajan, Annika Rosengren, Aletta E Schutte, Mariz Sintaha, Koon K Teo, Andreas Wielgosz, Karen Yeates, Lu Yin, Khalid Yusoff, Katarzyna Zatońska, Salim Yusuf, Martin McKee
BACKGROUND: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex...
March 2018: Lancet Global Health
Herfina Y Nababan, Md Hasan, Tiara Marthias, Rolina Dhital, Aminur Rahman, Iqbal Anwar
Purpose: Overall health status indicators have improved significantly over the past three decades in Indonesia. However, the country's maternal mortality ratio remains high with a stark inequality by region. Fewer studies have explored access inequity in maternal health care service over time using multiple inequality markers. In this study, we analyzed Indonesian Demographic and Health Survey (DHS) data to explore trends and inequities in use of any antenatal care (ANC), four or more ANC (ANC4+), institutional birth, and cesarean section (c-section) birth in Indonesia during 1986-2012 to inform policy for future strategies ending preventable maternal deaths...
2018: International Journal of Women's Health
Hastings T Banda, Rachael Thomson, Kevin Mortimer, George A F Bello, Grace B Mbera, Rasmus Malmborg, Brian Faragher, S Bertel Squire
BACKGROUND: No community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities. OBJECTIVE: To understand the prevalence of chronic respiratory symptoms and recorded diagnoses of TB in rural Malawian adults in order to improve case detection and management of these diseases...
2017: PloS One
Dawei Zhu, Na Guo, Jian Wang, Stephen Nicholas, Li Chen
BACKGROUND: China's health system has shown remarkable progress in health provision and health outcomes in recent decades, however inequality in health care utilization persists and poses a serious social problem. While government pro-poor health policies addressed affordability as the major obstacle to equality in health care access, this policy direction deserves further examination. Our study examines the issue of health care inequalities in China, analyzing both regional and individual socioeconomic factors associated with the inequality, and provides evidence to improve governmental health policies...
December 4, 2017: International Journal for Equity in Health
Marshall Makate, Clifton Makate
Background: Inequalities in maternal health care are pervasive in the developing world, a fact that has led to questions about the extent of these disparities across socioeconomic groups. Despite a growing literature on maternal health across Sub-Saharan African countries, relatively little is known about the evolution of these inequalities over time for specific countries. This study sought to quantify and explain the observed differences in prenatal care use and professional delivery assistance in Zimbabwe...
2017: Global Health Research and Policy
Collins C Iwuji, Joanna Orne-Gliemann, Joseph Larmarange, Eric Balestre, Rodolphe Thiebaut, Frank Tanser, Nonhlanhla Okesola, Thembisa Makowa, Jaco Dreyer, Kobus Herbst, Nuala McGrath, Till Bärnighausen, Sylvie Boyer, Tulio De Oliveira, Claire Rekacewicz, Brigitte Bazin, Marie-Louise Newell, Deenan Pillay, François Dabis
BACKGROUND: Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. METHODS: We did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older...
March 2018: Lancet HIV
Stefania Ilinca, Ricardo Rodrigues, Andrea E Schmidt
In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need...
October 14, 2017: International Journal of Environmental Research and Public Health
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