Zere Eyob, Moeti Matshidiso, Kirigia Joses, Mwase Takondwa, Kataika Edward
World Health Organization, Lilongwe, Malawi.
BMC Public Health. 2007 May 15;7:78. doi: 10.1186/1471-2458-7-78.
Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.
This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.
Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.
Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.
The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.
越来越多的科学证据表明，健康和医疗保健方面的不平等现象普遍存在，而且逆向医疗法则持续存在，即在发展中国家，高质量医疗保健的可及性似乎与其需求呈负相关。如果健康/医疗保健方面的不平等问题得不到妥善解决，千年发展目标的实现可能会受到影响。
本研究试图利用1992年、2000年和2004年人口与健康调查的数据，评估马拉维健康状况和医疗服务利用选定指标的不平等趋势。
使用五分位数比率和集中曲线/指数，分析1992年、2000年和2004年人口与健康调查的数据，以了解健康/医疗保健方面的不平等情况。
总体而言，研究结果表明，在大多数选定指标中存在有利于富人的不平等现象，而且在研究期间这些不平等现象一直在加剧。此外，在干预措施（五岁以下儿童腹泻、急性呼吸道感染的治疗）的使用方面存在纵向不平等，即这些疾病负担较轻的非贫困人口接受了更多的治疗/干预措施，而疾病负担较重的贫困人口使用的干预措施较少。还观察到，某些选定干预措施（如分娩）的公共提供服务使非贫困人口比贫困人口受益更多。
不平等现象的加剧趋势，特别是对已证实具有成本效益的干预措施的医疗保健利用，可能会危及千年发展目标以及其他国家和区域目标的实现。为了消除不平等现象，建议通过适当的目标设定机制和有效的服务提供策略，增加贫困社区的覆盖范围。还需要开展研究，以确定在马拉维背景下哪些服务提供机制是有效的。
