Inequity in costs of seeking sexual and reproductive health services in India and Kenya

International Journal for Equity in Health

Research

Sushena Reza-Paul¹  Anuradha Roy¹  Jolene Skordis-Worrall²  Hassan Haghparast-Bidgoli²  Anni-Maria Pulkki-Brännström³  Peter Gichangi⁴  Wilkister Ombidi⁴  Yves Lafort⁵  Mags Beksinska⁶  Letitia Rambally⁶ 

[1] Ashodaya Samithi (Ashodaya), Mysore, India;Institute for Global Health, University College London, London, UK;Institute for Global Health, University College London, London, UK;Epidemiology and Global Health, Umeå University, Umeå, Sweden;International Centre for Reproductive Health Association (ICRHK), Mombasa, Kenya;International Centre for Reproductive Health, Ghent University, Ghent, Belgium;MatCH (Maternal, Adolescent and Child Health), University of the Witwatersrand, Durban, South Africa;

关键词: Sexual and reproductive health services;    Inequity;    Kakwani index;    Catastrophic spending;   

DOI  :  10.1186/s12939-015-0216-5

 received in 2014-12-17, accepted in 2015-09-12,  发布年份 2015

来源: Springer

【 摘 要 】

ObjectiveThis study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending.MethodsData for this study were collected as a part of the situational analysis for the “Diagonal Interventions to Fast Forward Enhanced Reproductive Health” (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10 % of total household income.ResultsThe results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2 % and 0.03–7.5 % in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were “receiving [money] from partner or household members” (69 %) and “using own savings or regular income” (44 %), respectively.ConclusionHighly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family - although this requires further study.

【 授权许可】

CC BY   
© Haghparast-Bidgoli et al. 2015