Attacking Inequality in the Health Sector: A Synthesis of Evidence and Tools

World Bank Publications, 2009 - Medical - 308 pages

The last 10 years have seen a resurgence in interest and research around inequalities in the health sector. While a disproportionate share of the new research has focused on measuring inequality in the health sector, work is emerging on how to understand the causes of inequality and on identifying successful approaches for tackling the problem. This book summarizes the operational lessons emerging from this new focus. It is intended to be an operational resource for change agents within and outside government in low and middle countries committed to improve access and use of critical health services to income poor and social vulnerable populations.

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1 An Unacceptable Reality	1

Figure 11 Regional Inequalities in Health Sector Outcomes	5

Box 11 Variations in Health and Fertility Outcomes in India	7

Table 11 Health Services with the Largest Measure of Inequality	9

Figure 12 Use of Basic Maternal and Child Health Services Coverage Rates among the Poorest and Wealthiest 20 Percent of the Population in 56 Low...	10

Coverage Rate Ratios for the Wealthiest and Poorest 20 Percent 56 Low and MiddleIncome Countries	11

Figure 14 PopulationWeighted Regional Averages of Percentage of Pregnant Women in the Poorest and Wealthiest Quintiles Who Receive Three or ...	12

Figure 15 PopulationWeighted Regional Averages of Percentage of Deliveries for the Poorest and Wealthiest Quintiles That Were Attended by a Med...	14

Table 52 Proportion of Mothers Receiving Inadequate Antenatal Care by Wealth Quintiles and Concentration Indexes	175

Figure 51 Distribution of Wealth Status for Residents of Areas Covered by the Family Health Program PSF	177

Contracting with Nongovernmental Organizations to Serve the Poor	179

Table 61 Average Annual Recurrent Expenditure per Capita	181

Definitions and Coverage Goals	183

Figure 61 Changes in Concentration Indexes 19972003	184

Health Equity Fund for the Poor	187

Table 71 Procedures and Criteria Used in Four HEFs to Identify the Poorest	191

Figure 16 PopulationWeighted Regional Averages of Percentage of Fully Immunized Children from the Poorest and Wealthiest Quintiles	15

Figure 17 Selected Benefit Incidence Findings for Public Spending on Health	16

Box 13 Benefit Incidence Analysis at the Subnational Level	18

Figure 18 Wealth Gap for Full Immunization India 199899	19

The Likelihood of Infant Death in the Poorest Quintile of Families Relative to That in the Wealthiest Quintile Rural and Urban India 199899	20

Figure 110 Inequality in Full Immunization India 199899	21

Figure 111 Concentration Curves of Infant Mortality Rates in India 199899	22

Table A11 Assets and Factor Scores Urban India 199899	25

Figure A11 Concentration Curves for Full Immunization Rural and Urban India	28

Table A13 Infant Mortality Inequalities in Low and MiddleIncome Countries	30

Table A14 Adolescent Fertility Inequalities in Low and MiddleIncome Countries	36

Table A15 Severe Stunting Inequalities in Low and MiddleIncome Countries	42

Table A16 Full Immunization Inequalities in Low and MiddleIncome Countries	48

Table A17 Antenatal Care Three or More Visits Inequalities in Low and MiddleIncome Countries	54

Table A18 Contraception Women Inequalities in Low and MiddleIncome Countries	60

Table A19 Attended Delivery Inequalities in Low and MiddleIncome Countries	66

2 Approaching a Complex and Persistent Problem	79

The PRSP Pathways Framework	80

Box 21 Why Did Safar Banu Die?	82

Figure 22 Eight Steps to Effective Use of Health Services by the Poor	85

Table A21 Potential for Multisectoral Synergies to Achieve the Millennium Development Goals for Health and Nutrition	95

3 The Importance of Listening	103

Table 31 Immunization Coverage of Children in India by Wealth Quintile 199293	111

Figure 31 Physical Access and Regional Poverty Levels Mauritania 1999	118

Figure 32 Regional Drug Affordability Cameroon	119

Figure 33 Perception of Quality Cameroon	121

Figure 34 Relevance of Services by Age Mauritania and Benin 1998	122

Figure 35 Continuity of Immunizations Mozambique 1997	124

Figure 36 Participation by Region Mauritania 2000	126

Figure 37 Share of Public Subsidy for Curative Care by Income Group	128

Figure 38 Subsidy Benefits Concentration Curve by Type of Care	129

Figure 39 Subsidy Benefits Concentration Curve for Curative Care by Residence	130

Box 31 Determining How HealthFinancing Policy Choices Affect Inequality in Service Use	132

Figure 310 Benefit and Tax Incidence for the Health Sector in Canada	134

Table A31 Data Sources and Their Limitations	144

4 A Menu of ProPoor Policies	157

Figure 41 Results from Studies Presented at RPP Conference	159

Table 41 A Menu of ProPoor Policies	161

Figure A41 Service Delivery Accountability Framework	165

5 Brazil Filling the Cracks in Universal Coverage	173

Table 51 Prevalence of Incomplete Immunization among Children 12 Months and Older by Wealth Quintiles and Concentration Indexes	174

Figure 71 Hospitalizations for HEF Beneficiaries and Nonbeneficiaries in the Four HEFs	194

Integrated Services Program for the Poor	197

Box 81 Illustrative Minimum Conditions to be Achieved by Chile Solidario Participants	200

Figure 81 Chile Solidario Participants by Economic Group 2003	203

Expanding Health Insurance for the Poor	205

Figure 91 Population Who Paid for Inpatient Care in Public Hospitals by Income Level	207

Figure 92 Insured Population by Income Status	209

Table 91 Individuals Pushed below Poverty and Subsistence Lines by a Health Shock	210

Figure 93 Reasons for Not Seeking Health Care 2003	211

Figure 94 Impact of Institutional Delivery and Prenatal Care on Infant Mortality Rate	212

CommunityBased Health Care Services	215

Table 101 The Three SEWA Health Services Covered by Reaching the Poor	217

Figure 101 Frequency Distribution of SEWA Reproductive Health Mobile Camp Users Urban and Rural by Deciles of the SES Index Score	219

Health Cards for the Poor	223

Figure 111 Outpatient Consultations by Type of Provider	224

Figure 112 Health Card Ownership versus Use for Outpatient Treatment	225

Table 111 Health Card Use	226

Expanding Immunization Reach through Campaigns	229

Table 121 Measles Immunization Coverage in Kenya before and after the 2002 CatchUp Campaign	232

Figure 121 Percentage of Children Covered by Kenyas 2002 Mass Campaign Who Had Not Previously Received Measles Immunization	233

Health Financing Reform and the Poor	235

Figure 131 Effect of Reforms on Hospital OutofPocket Payments Conditional on Hospitalization	238

Paying the Poor to Use Health Services	241

Figure 141 PROGRESAOportunidadess Success in Reaching the Poor	244

Providing Subsidized Health Insurance to the Poor	247

Figure 151 Enrollment in Mexicos Seguro Popular Program by Economic Level	251

Participatory Planning	255

First Pregnancy Poor and Nonpoor Young Married Women Nepal	257

CommunityBased Health Insurance	261

Figure 171 Proportion of Sick Seeking Care from Modern Provider by Income Quartile 2000	264

Figure 172 OutofPocket IllnessRelated Expenditures	265

Social Marketing for Malaria Prevention	269

Figure 181 Household Net Ownership before and after Social Marketing Program by Socioeconomic Status	274

Table 181 Protective Efficacy of InsecticideTreated and Untreated Nets in Kilombero and Ulanga Districts of Southwestern Tanzania 1999	275

19 Vigilance	277

Figure 191 Three Classes of Health Services	282

Figure 192 Tracking Drug Expenses in Africa in the 1980s	284

References	289

Index	295

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Attacking Inequality in the Health Sector: A Synthesis of Evidence and Tools
Abdo Yazbeck
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2nd 3rd 4th Africa allocation analysis antenatal areas asset Bangladesh beneficiaries benefits Benin better-off Burkina Faso Cambodia Cameroon CBHI schemes chapter Colombia Concentration index conditional cash transfers Côte d'Ivoire coverage delivery Development Difference between poorest districts expenditures factors families Figure funds Ghana groups Gwatkin health card health care health facility health insurance health outcomes health sector health services Health Surveys health system hospital household survey identify immunization impact implemented improve income increase India interventions Kazakhstan Kenya malaria Mauritania measure middle-income countries Millennium Development Goals monitoring Mozambique Nepal NGOs nutrition oblasts participation poorest 20 percent poorest and Ratio poorest quintile poorest to quintiles poverty pro-poor quintile quintile 2nd 3rd Ratio of wealthiest Reaching the Poor reforms region reproductive health rural Rwanda SEWA socioeconomic Solidario Source subsidies survey quintile 2nd Tanzania target tion urban women World Bank Yazbeck Zimbabwe

Bibliographic information

Title	Attacking Inequality in the Health Sector: A Synthesis of Evidence and Tools World Bank e-Library
Author	Abdo Yazbeck
Contributor	World Bank
Edition	illustrated
Publisher	World Bank Publications, 2009
ISBN	082137740X, 9780821377406
Length	308 pages
Subjects	Medical › Health Care Delivery Medical / Health Care Delivery Medical / Health Policy Medical / Public Health

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Attacking Inequality in the Health Sector: A Synthesis of Evidence and Tools

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