Analyzing the equity of public primary care provision in Kenya: variation in facility characteristics by local poverty level.
Analyzing the equity of public primary care provision in Kenya: variation in facility characteristics by local poverty level.
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DOI：
10.1186/1475-9276-11-75
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发表时间：
2012-12-13
影响因子：
4.8
通讯作者：
Goodman C
中科院分区：
文献类型：
--
作者：
Toda M;Opwora A;Waweru E;Noor A;Edwards T;Fegan G;Molyneux C;Goodman C
公平获得保健服务是卫生系统的一个关键目标，在低收入国家尤其令人关切。在肯尼亚，公共设施是穷人的一项重要资源，但对服务提供的公平性知之甚少。本文通过调查公共设施特征与设施所在地区的贫困水平之间的关联，评估贫困地区是否有较差的卫生服务。从肯尼亚所有8个省的公共卫生中心和药房的全国代表性样本中收集有关设施特征的数据。采用两阶段整群随机抽样方法选择设施。设施的特点和社会经济地位（SES）的设施所在的地区之间的单变量关联进行了评估，使用卡方检验，权益比率和浓度指数。间接标准化的集中度指数被用来评估SES对设施投入和服务可用性的影响，同时控制设施类型，省份和偏远地区。对于大多数指标，我们没有发现任何迹象表明SES的变化。电力和实验室服务是明显的例外，它们显示出有利于富人的不平等，公平比率为3.16和3.43，集中指数为0.09（p<0.01）和0.05（p=0.01），间接标准化集中比率为0.07（p<0.01）和0.05（p=0.01）。还有一些迹象表明，在药物供应和合格工作人员方面存在有利于富人的不平等现象。缺乏其他指标不平等的证据并不意味着投入和服务的可获得性总是很高;例如，供水和计划生育服务的可获得性接近90%，但提供交付服务或外联服务的设施不到一半。本文展示了如何将当地贫困数据与国家卫生设施调查相结合，为决策者评估投入和服务提供的公平性提供了一种工具。除了电力和实验室服务外，几乎没有证据表明大多数投入和服务存在不平等。然而，无论社会经济状况如何，都需要努力改善所有地区公共设施的关键投入和服务的可用性。
Equitable access to health care is a key health systems goal, and is a particular concern in low-income countries. In Kenya, public facilities are an important resource for the poor, but little is known on the equity of service provision. This paper assesses whether poorer areas have poorer health services by investigating associations between public facility characteristics and the poverty level of the area in which the facility is located. Data on facility characteristics were collected from a nationally representative sample of public health centers and dispensaries across all 8 provinces in Kenya. A two-stage cluster randomized sampling process was used to select facilities. Univariate associations between facility characteristics and socioeconomic status (SES) of the area in which the facility was located were assessed using chi-squared tests, equity ratios and concentration indices. Indirectly standardized concentration indices were used to assess the influence of SES on facility inputs and service availability while controlling for facility type, province, and remoteness. For most indicators, we found no indication of variation by SES. The clear exceptions were electricity and laboratory services which showed evidence of pro-rich inequalities, with equity ratios of 3.16 and 3.43, concentration indices of 0.09 (p<0.01) and 0.05 (p=0.01), and indirectly standardized concentration ratios of 0.07 (p<0.01) and 0.05 (p=0.01). There were also some indications of pro-rich inequalities for availability of drugs and qualified staff. The lack of evidence of inequality for other indicators does not imply that availability of inputs and services was invariably high; for example, while availability was close to 90% for water supply and family planning services, under half of facilities offered delivery services or outreach. The paper shows how local area poverty data can be combined with national health facility surveys, providing a tool for policy makers to assess the equity of input and service availability. There was little evidence of inequalities for most inputs and services, with the clear exceptions of electricity and laboratory services. However, efforts are required to improve the availability of key inputs and services across public facilities in all areas, regardless of SES.
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