Equity and determinants in universal health coverage indicators in Iraq, 2000–2030: a national and subnational study

International Journal for Equity in Health

Ashraf Hussain¹  Masahiro Hashizume²  Md Rashedul Islam²  Nadia Parsell²  Hiroko Taniguchi²  Md Mizanur Rahman³  Khin Thet Swe³  Md Shafiur Rahman⁴  Kenji Shibuya⁵ 

[1] Department of Family and Community Medicine, College of Medicine, University of Babylon, Babil, Iraq;Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, 113-0033, Bunkyo-ku, Tokyo, Japan;Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, 113-0033, Bunkyo-ku, Tokyo, Japan;Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1, Naka, 186-8601, Kunitachi, Tokyo, Japan;Research Center for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, 431-3192, Hamamatsu, Shizuoka, Japan;United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan;Soma COVID Vaccination Medical Center, Soma City Hall, 63-3, Kitamachi, Nakamura, Soma, 976-8601, Fukushima, Japan;

关键词: Universal health coverage;    Equity;    Social determinants;    Catastrophic health payment;    Bayesian analysis;   

DOI  :  10.1186/s12939-021-01532-0

来源: Springer

【 摘 要 】

BackgroundEquity is one of three dimensions of universal health coverage (UHC). However, Iraq has had capital-focused health services and successive conflicts and political turmoil have hampered health services around the country. Iraq has embarked on a new reconstruction process since 2018 and it could be time to aim for equitable healthcare access to realise UHC. We aimed to examine inequality and determinants associated with Iraq’s progress towards UHC targets.MethodsWe assessed the progress toward UHC in the context of equity using six nationally representative population-based household surveys in Iraq in 2000–2018. We included 14 health service indicators and two financial risk protection indicators in our UHC progress assessment. Bayesian hierarchical regression model was used to estimate the trend, projection, and determinant analyses. Slope and relative index of inequality were used to assess wealth-based inequality.ResultsIn the national-level health service indicators, inequality indices decreased substantially from 2000 to 2030. However, the wide inequalities are projected to remain in DTP3, measles, full immunisations, and antenatal care in 2030. The pro-rich inequality gap in catastrophic health expenditure increased significantly in all governorates except Sulaimaniya from 2007 to 2012. The higher increases in pro-rich inequality were found in Missan, Karbala, Erbil, and Diala. Mothers’ higher education and more antenatal care visits were possible factors for increased coverage of health service indicators. The higher number of children and elderly population in the households were potential risk factors for an increased risk of catastrophic and impoverishing health payment in Iraq.ConclusionsTo reduce inequality in Iraq, urgent health-system reform is needed, with consideration for vulnerable households having female-heads, less educated mothers, and more children and/or elderly people. Considering varying inequity between and within governorates in Iraq, reconstruction of primary healthcare across the country and cross-sectoral targeted interventions for women should be prioritised.

【 授权许可】

CC BY