Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
J Glob Health. 2023 Jan 27;13:04008. doi: 10.7189/jogh.13.04008.
Despite large investments in the public health care system, disparities in health outcomes persist between lower- and upper-income individuals, as well as rural vs urban dwellers in Ethiopia. Evidence from Ethiopia and other low- and middle-income countries suggests that challenges in health care access may contribute to poverty in these settings.
We employed a two-step floating catchment area to estimate variations in spatial access to health care and in staffing levels at health care facilities. We estimated the average travel time from the population centers of administrative areas and adjusted them with provider-to-population ratios. To test hypotheses about the role of travel time vs staffing, we applied Spearman's rank tests to these two variables against the access score to assess the significance of observed variations.
Among Ethiopia's 11 first-level administrative units, Addis Ababa, Dire Dawa, and Harari had the best access scores. Regions with the lowest access scores were generally poorer and more rural/pastoral. Approximately 18% of the country did not have access to a public health care facility within a two-hour walk. Our results suggest that spatial access and staffing issues both contribute to access challenges.
Investments both in new health facilities and staffing in existing facilities will be necessary to improve health care access within Ethiopia. Because rural and low-income areas are more likely to have poor access, future strategies for expanding and strengthening the health care system should strongly emphasize equity and the role of improved access in reducing poverty.
尽管在公共医疗保健系统投入了大量资金，但在埃塞俄比亚，收入较低的人群与收入较高的人群以及农村居民与城市居民之间的健康结果仍存在差距。来自埃塞俄比亚和其他中低收入国家的证据表明，医疗保健获取方面的挑战可能导致这些地方的贫困。
我们采用两步浮动集水区法来估计医疗保健空间获取和医疗保健设施人员配备水平的变化。我们估算了行政区域人口中心的平均出行时间，并根据服务提供者与人口的比例对其进行了调整。为了检验出行时间与人员配备对获取情况的影响，我们对这两个变量与获取评分进行了斯皮尔曼等级相关检验，以评估观察到的变化的显著性。
在埃塞俄比亚的 11 个一级行政区中，亚的斯亚贝巴、德雷达瓦和哈拉里的获取评分最高。获取评分最低的地区通常较为贫穷，且以农村/畜牧业为主。约有 18%的国家无法在两小时步行范围内获得公共医疗保健设施。我们的结果表明，空间获取和人员配备问题都对获取挑战产生了影响。
埃塞俄比亚需要在新的医疗设施投资和现有设施的人员配备方面进行投资，以改善医疗保健的获取情况。由于农村和低收入地区更有可能难以获取医疗服务，未来扩大和加强医疗保健系统的战略应强烈强调公平性以及改善获取对减少贫困的作用。
