Attacking Inequality in the Health Sector

A Synthesis of Evidence and Tools

Abdo S. Yazbeck

• Publisher: World Bank Publications
• Year: 2009
• eBook ISBN: 9780821377406
• Edition: 0
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Shattering myths about health equity, this book offers a path forward for a healthier world. This groundbreaking work reveals the stark reality of health inequalities in low- and middle-income countries, where poverty dramatically impacts access to care and health outcomes. It's more than just a problem description; it's a call to action.This book provides a practical framework for policymakers, advocates, and development agencies. It offers:

• A synthesis of evidence on what works (and what doesn't) in reducing health disparities.
• A practical "how-to" manual for understanding and addressing inequality in health service use.
• Evaluations of 14 proven successes, offering concrete strategies for change.

Discover how to design effective policies, allocate resources strategically, and empower communities to build a more equitable health system. This is your guide to creating lasting change and improving health for the world's most vulnerable populations.

Table of contents

• Contents
• Foreword
• Preface
• Acknowledgments
• Abbreviations
• 1. An Unacceptable Reality
• 2. Approaching a Complex and Persistent Problem
• 3. The Importance of “Listening”
• 4. A Menu of Pro-Poor Policies
• 5. Brazil, Filling the Cracks in Universal Coverage
• 6. Cambodia: Contracting with Nongovernmental Organizations to Serve the Poor
• 7. Cambodia: Health Equity Fund for the Poor
• 8. Chile: Integrated Services Program for the Poor
• 9. Colombia: Expanding Health Insurance for the Poor
• 10. India: Community-Based Health Care Services
• 11. Indonesia: Health Cards for the Poor
• 12. Kenya: Expanding Immunization Reach through Campaigns
• 13. The Kyrgyz Republic: Health Financing Reform and the Poor
• 14. Mexico: Paying the Poor to Use Health Services
• 15. Mexico: Providing Subsidized Health Insurance to the Poor
• 16. Nepal: Participatory Planning
• 17. Rwanda: Community-Based Health Insurance
• 18. Tanzania: Social Marketing for Malaria Prevention
• 19 Vigilance
• References
• Index
• Figure 1.1 Regional Inequalities in Health Sector Outcomes
• Figure 1.2 Use of Basic Maternal and Child Health Services, Coverage Rates among the Poorest and Wealthiest 20 Percent of the Population in 56 Low- and Middle-Income Countries
• Figure 1.3 Inequalities in the Use of Basic Maternal and Child Health Services: Coverage Rate Ratios for the Wealthiest and Poorest 20 Percent, 56 Low- and Middle-Income Countries
• Figure 1.4 Population-Weighted Regional Averages of Percentage of Pregnant Women in the Poorest and Wealthiest Quintiles Who Receive Three or More Antenatal Visits
• Figure 1.5 Population-Weighted Regional Averages of Percentage of Deliveries for the Poorest and Wealthiest Quintiles That Were Attended by a Medically Trained Person
• Figure 1.6 Population-Weighted Regional Averages of Percentage of Fully Immunized Children from the Poorest and Wealthiest Quintiles
• Figure 1.7 Selected Benefit Incidence Findings for Public Spending on Health
• Figure 1.8 Wealth Gap for Full Immunization, India, 1998–99
• Figure 1.9 Odds Ratios for Infant Morality: The Likelihood of Infant Death in the Poorest Quintile of Families Relative to That in the Wealthiest Quintile, Rural and Urban India, 1998–99
• Figure 1.10 Inequality in Full Immunization, India, 1998–99
• Figure 1.11 Concentration Curves of Infant Mortality Rates in India, 1998–99
• Figure 1.12 Immunization Concentration Curves, Selected Indian States, 1998–99
• Figure A1.1 Concentration Curves for Full Immunization, Rural and Urban India
• Figure 2.1 Determinants of Health Outcomes: The PRSP Pathways Framework
• Figure 2.2 Eight Steps to Effective Use of Health Services by the Poor
• Figure 3.1 Physical Access and Regional Poverty Levels, Mauritania, 1999
• Figure 3.2 Regional Drug Affordability, Cameroon
• Figure 3.3 Perception of Quality, Cameroon
• Figure 3.4 Relevance of Services by Age, Mauritania and Benin, 1998
• Figure 3.5 Continuity of Immunizations, Mozambique, 1997
• Figure 3.6 Participation by Region, Mauritania, 2000
• Figure 3.7 Share of Public Subsidy for Curative Care by Income Group
• Figure 3.8 Subsidy Benefits Concentration Curve by Type of Care
• Figure 3.9 Subsidy Benefits Concentration Curve for Curative Care by Residence
• Figure 3.10 Benefit and Tax Incidence for the Health Sector in Canada
• Figure 4.1 Results from Studies Presented at RPP Conference
• Figure A4.1 Service Delivery Accountability Framework
• Figure 5.1 Distribution of Wealth Status for Residents of Areas Covered by the Family Health Program (PSF)
• Figure 6.1 Changes in Concentration Indexes, 1997–2003
• Figure 7.1 Hospitalizations for HEF Beneficiaries and Nonbeneficiaries in the Four HEFs
• Figure 8.1 Chile Solidario Participants by Economic Group, 2003
• Figure 8.2 Estimated Chile Solidario Participants by Economic Group, 2006
• Figure 9.1 Population Who Paid for Inpatient Care in Public Hospitals by Income Level
• Figure 9.2 Insured Population, by Income Status
• Figure 9.3 Reasons for Not Seeking Health Care, 2003
• Figure 9.4 Impact of Institutional Delivery and Prenatal Care on Infant Mortality Rate
• Figure 10.1 Frequency Distribution of SEWA Reproductive Health Mobile Camp Users, Urban and Rural, by Deciles of the SES Index Score
• Figure 11.1 Outpatient Consultations, by Type of Provider
• Figure 11.2 Health Card Ownership versus Use for Outpatient Treatment
• Figure 12.1 Percentage of Children Covered by Kenya’s 2002 Mass Campaign Who Had Not Previously Received Measles Immunization
• Figure 13.1 Effect of Reforms on Hospital Out-of-Pocket Payments, Conditional on Hospitalization
• Figure 14.1 PROGRESA/Oportunidades’s Success in Reaching the Poor
• Figure 15.1 Enrollment in Mexico’s Seguro Popular Program by Economic Level
• Figure 16.1 Delivery in a Medical Facility: First Pregnancy, Poor and Nonpoor Young Married Women, Nepal
• Figure 17.1 Proportion of Sick Seeking Care from Modern Provider, by Income Quartile, 2000
• Figure 17.2 Out-of-Pocket Illness-Related Expenditures
• Figure 18.1 Household Net Ownership before and after Social Marketing Program, by Socioeconomic Status
• Figure 19.1 Three Classes of Health Services
• Figure 19.2 Tracking Drug Expenses in Africa in the 1980s
• Table 1.1 Health Services with the Largest Measure of Inequality
• Table A1.1 Assets and Factor Scores, Urban India, 1998–99
• Table A1.2 Household Wealth Quintiles, Urban India, 1998–99
• Table A1.3 Infant Mortality Inequalities in Low- and Middle-Income Countries
• Table A1.4 Adolescent Fertility Inequalities in Low- and Middle-Income Countries
• Table A1.5 Severe Stunting Inequalities in Low- and Middle-Income Countries
• Table A1.6 Full Immunization Inequalities in Low- and Middle-Income Countries
• Table A1.7 Antenatal Care (Three or More Visits) Inequalities in Low- and Middle-Income Countries
• Table A1.8 Contraception (Women) Inequalities in Low- and Middle-Income Countries
• Table A1.9 Attended Delivery Inequalities in Low- and Middle-Income Countries
• Table A2.1 Potential for Multisectoral Synergies to Achieve the Millennium Development Goals for Health and Nutrition
• Table 3.1 Immunization Coverage of Children in India, by Wealth Quintile, 1992–93
• Table A3.1 Data Sources and Their Limitations
• Table 4.1 A Menu of Pro-Poor Policies
• Table 5.1 Prevalence of Incomplete Immunization among Children 12 Months and Older, by Wealth Quintiles, and Concentration Indexes
• Table 5.2 Proportion of Mothers Receiving Inadequate Antenatal Care, by Wealth Quintiles, and Concentration Indexes
• Table 6.1 Average Annual Recurrent Expenditure per Capita
• Table 6.2 Health Service Indicators: Definitions and Coverage Goals
• Table 7.1 Procedures and Criteria Used in Four HEFs to Identify the Poorest
• Table 9.1 Individuals Pushed below Poverty and Subsistence Lines by a Health Shock
• Table 10.1 The Three SEWA Health Services Covered by Reaching the Poor
• Table 11.1 Health Card Use
• Table 12.1 Measles Immunization Coverage in Kenya before and after the 2002 Catch-Up Campaign
• Table 18.1 Protective Efficacy of Insecticide-Treated and Untreated Nets in Kilombero and Ulanga Districts of Southwestern Tanzania, 1999
• Box 1.1 Variations in Health and Fertility Outcomes in India
• Box 1.2 Variations in Health Service Use in India
• Box 1.3 Benefit Incidence Analysis at the Subnational Level
• Box 2.1 Why Did Safar Banu Die?
• Box 3.1 Determining How Health-Financing Policy Choices Affect Inequality in Service Use
• Box 8.1 Illustrative Minimum Conditions to be Achieved by Chile Solidario Participants