Utilisation of Health Services and Geography: Deconstructing Regional Differences in Barriers to Facility-Based Delivery in Nepal
Utilisation of Health Services and Geography: Deconstructing Regional Differences in Barriers to Facility-Based Delivery in Nepal
复制标题
DOI：
10.1007/s10995-014-1540-x
复制
发表时间：
2015-03-01
影响因子：
2.3
通讯作者：
Jimenez-Soto, Eliana
中科院分区：
文献类型：
--
作者：
Hodge, Andrew;Byrne, Abbey;Jimenez-Soto, Eliana
虽然地理上的不便是利用卫生服务的一个主要障碍，但目前尚不清楚这种差异是否仅是由于获得这些服务的机会有限造成的，还是也归因于健康行为。尼泊尔山区与该国其他地区之间的健康结果和许多关键卫生服务的覆盖率存在显着差异，但造成这些区域差异的主要因素尚不清楚。我们利用 2011 年尼泊尔人口和健康调查的全国代表性数据，研究了可观察因素在多大程度上解释了孕产妇保健服务利用方面的总体差异。我们应用非线性 Blinder-Oaxaca 型分解方法来量化可测量特征的差异对基于设施的交付的区域覆盖差距的影响。山区和尼泊尔其他地区的设施配送平均覆盖率分别为 18.6% 和 36.3%。 54.8% 至 74.1% 的区域覆盖率差距是由观察到的特征差异造成的。影响健康行为的因素（以母亲的教育程度、电视收视率和烟草使用情况以及家庭财富为代表）以及与医疗机构的主观距离是主要因素，造成了 52.9% 至 62.5% 的差异。母亲的出生史也值得注意。同时解决获取和健康行为问题的政策似乎有必要为偏远地区的妇女和儿童实现更大的覆盖范围和更好的健康结果。
While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.