Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, 42 Avenue Kumda-Yonre, Kadiogo 11 BP 218 Ouagadougou CMS 11, Ouagadougou, Burkina Faso.
Centre for Research on Planning and Development (CRAD), Laval University, Quebec, G1V 0A6, Canada.
Int J Equity Health. 2021 May 21;20(1):124. doi: 10.1186/s12939-021-01474-7.
Socioeconomic inequalities between and within countries lead to disparities in the use of health services. These disparities could lead to child mortality in children under 5 years by depriving them of healthcare. Therefore, initiatives to remove healthcare fees such as the Free Healthcare Initiative (FHCI) adopted in Sierra Leone can contribute to reducing these inequities in healthcare-seeking for children. This study aimed to assess the socioeconomic inequalities in healthcare-seeking for children under 5 years of age before and after the implementation of the FHCI.
Data were included on 1207, 2815, 1633, and 1476 children under 5 years of age with fever from the 2008, 2013, 2016, and 2019 nationwide surveys, respectively. Concentration curves were drawn for the period before (2008) and after (2013-2019) the implementation of the FHCI to assess socioeconomic inequalities in healthcare-seeking. Finally, Erreyger's corrected concentration indices were calculated to understand the magnitude of these inequalities.
Before the implementation of the FHCI, there were inequalities in healthcare-seeking for children under five (Erreyger's corrected concentration index (CI) = 0.168, standard error (SE) = 0.049; p < 0.001) in favor of the wealthy households. These inequalities decreased after the implementation of the FHCI (CI = 0.061, SE = 0.033; p = 0.06 in 2013, CI = 0.039, SE = 0.04; p = 0.32 in 2016, and CI = - 0.0005, SE = 0.362; p = 0.98 in 2019). Furthermore, before the implementation of the FHCI, a significant pro-rich inequality in the districts of Kenema (CI = 0.117, SE = 0.168, p = 0.021), Kono (CI = 0.175, SE = 0.078, p = 0.028) and Western Area Urban (CI = 0.070, SE = 0.032, p = 0.031) has been observed. After the implementation of the FHCI in 2019, these disparities were reduced, 11 of the 14 districts had a CI around the value of equality, and only in 2 districts the pro-rich inequality were significant (Western Area Urban (CI = 0.035, SE = 0.016, p = 0.039) and Western Area Rural (CI = 0.066, SE = 0.030, p = 0.027)).
The results of this study demonstrated that socio-economic inequalities in healthcare-seeking for children have been considerably reduced after the FHCI in Sierra Leone. To further reduce these inequalities, policy actions can focus on the increase of availability of health services in the districts where the healthcare-seeking remained pro-rich.
国家内部和国家之间的社会经济不平等导致卫生服务利用方面存在差异。这些差异可能导致 5 岁以下儿童因缺乏医疗保健而死亡。因此，塞拉利昂采取了取消医疗费用的举措，如实施免费医疗倡议，可以有助于减少儿童在寻求医疗保健方面的这些不平等。本研究旨在评估在实施免费医疗倡议前后，5 岁以下儿童寻求医疗服务的社会经济不平等情况。
纳入了分别来自 2008 年、2013 年、2016 年和 2019 年全国调查的 1207、2815、1633 和 1476 名发热的 5 岁以下儿童的数据。绘制了实施免费医疗倡议前后（2008 年和 2013-2019 年）期间的集中曲线，以评估寻求医疗服务的社会经济不平等情况。最后，计算了 Erreyger 校正的集中指数，以了解这些不平等的程度。
在实施免费医疗倡议之前，5 岁以下儿童的医疗服务寻求存在不平等（Erreyger 校正的集中指数（CI）=0.168，标准误差（SE）=0.049；p<0.001），有利于富裕家庭。在实施免费医疗倡议后，这些不平等现象有所减少（2013 年 CI=0.061，SE=0.033；p=0.06，2016 年 CI=0.039，SE=0.04；p=0.32，2019 年 CI=-0.0005，SE=0.362；p=0.98）。此外，在实施免费医疗倡议之前，在凯内马（CI=0.117，SE=0.168，p=0.021）、科诺（CI=0.175，SE=0.078，p=0.028）和西部区城市（CI=0.070，SE=0.032，p=0.031）地区观察到显著的亲富不平等现象。在 2019 年实施免费医疗倡议后，这些差距有所缩小，14 个地区中有 11 个地区的 CI 值接近平等，只有 2 个地区的亲富不平等现象仍然显著（西部区城市（CI=0.035，SE=0.016，p=0.039）和西部区农村（CI=0.066，SE=0.030，p=0.027））。
本研究结果表明，在塞拉利昂实施免费医疗倡议后，儿童在寻求医疗服务方面的社会经济不平等状况有了显著改善。为了进一步减少这些不平等现象，可以采取政策行动，重点增加在医疗服务仍然亲富的地区的卫生服务供应。
