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

Front Cover
World Bank Publications, 2009 - Medical - 308 pages
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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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Contents

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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