Department of Public Administration and Health Services Management, University of Ghana Business School, P. O. Box 78, Legon, Accra, Ghana.
BMC Public Health. 2019 Nov 21;19(1):1541. doi: 10.1186/s12889-019-7865-z.
The paper argues that unlike the income literature, the public health literature has not paid much attention to the distribution of substantial improvements in health outcomes over the last decade or more, especially, in the Sub-Saharan African (SSA) context. Thus, the paper examines current levels of utilisation, changes in utilisation as well as inequality in utilisation of reproductive health services over the last 10 years in SSA.
The paper uses two rounds of Demographic and Health Survey (DHS) data from 30 SSA countries (latest round) and 21 countries (earlier round) to compute simple frequencies, cross-tabulated frequencies and concentration indices for health facility deliveries, skilled delivery assistance, 4+ antenatal visits and use of modern contraceptives.
The results confirm the fact that utilisation of the selected reproductive health services have improved substantially over the last 10 year in several SSA countries. However, current levels of inequality in the use of reproductive health services are high in many countries. Interestingly, Guinea's pro-poor inequality in health facility delivery and skilled attendance at birth changed to pro-rich inequality, with the reverse being true in the case of use of modern contraceptives for Ghana, Malawi and Rawanda. The good news however is that in a lot of countries, the use of reproductive health services has increased while inequality has decreased within the period under study.
The paper argue that whiles income levels may play a key role in explaining the differences in utilisation and the levels of inequality, indepth studies may be needed to explain the reason for differential improvements and stagnation or deterioration in different countries. In this way, best practices from better performing countries can be documented and adapted by poor performing countries to improve their situation.
本文认为，与收入文献相比，公共卫生文献并没有过多关注过去十年或更长时间以来健康结果的实质性改善的分配情况，尤其是在撒哈拉以南非洲（SSA）地区。因此，本文考察了过去十年中 SSA 国家生殖健康服务的利用水平、利用变化以及利用不平等情况。
本文使用来自 30 个 SSA 国家（最新一轮）和 21 个国家（较早一轮）的两轮人口与健康调查（DHS）数据，计算了卫生设施分娩、熟练分娩援助、4 次以上产前检查和现代避孕措施的简单频率、交叉表频率和集中指数。
结果证实，过去十年中，几个 SSA 国家的选定生殖健康服务的利用水平有了显著提高。然而，许多国家生殖健康服务利用的不平等程度仍然很高。有趣的是，几内亚在卫生设施分娩和熟练助产方面的有利于穷人的不平等状况转变为有利于富人的不平等状况，而加纳、马拉维和卢旺达的情况则相反，现代避孕措施的使用情况从有利于穷人转变为有利于富人。然而，好消息是，在许多国家，生殖健康服务的利用增加了，而不平等程度在研究期间有所下降。
本文认为，尽管收入水平可能是解释利用差异和不平等程度的关键因素，但可能需要深入研究来解释不同国家改善和停滞或恶化的原因。通过这种方式，可以记录表现较好的国家的最佳实践，并由表现较差的国家进行改编，以改善其状况。
