Inequalities in healthcare resources and outcomes threatening sustainable health development in Ethiopia: panel data analysis

• Published in: BMJ open Vol. 9; no. 1; p. e022923
• Main Authors: Woldemichael, Abraha, Takian, Amirhossein, Akbari Sari, Ali, Olyaeemanesh, Alireza
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-01-2019; BMJ Publishing Group
• Subjects: Child mortality; Data Analysis; Decentralization; Demographics; Ethiopia; Expenditures; Financing, Government - organization & administration; Geography; Health care policy; Health Expenditures - statistics & numerical data; Health Policy; Health Services Accessibility - economics; Health Workforce - trends; Healthcare Disparities - economics; Hospitals; Humans; Inequality; Longitudinal studies; Politics; Population; Public health; Rural areas; Trends; Ethiopia; China; inequality; inequality decomposition; ethiopia; gini index; healthcare outcomes; healthcare resources
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-022923

ObjectiveTo measure inequalities in the distributions of selected healthcare resources and outcomes in Ethiopia from 2000 to 2015.DesignA panel data analysis was performed to measure inequalities in distribution of healthcare workforce, infrastructure, outcomes and finance, using secondary data.SettingThe study was conducted across 11 regions in Ethiopia.ParticipantsRegional population and selected healthcare workforce.Outcomes measuredAggregate Theil and Gini indices, changes in inequalities and elasticity of healthcare resources.ResultsDespite marked inequality reductions over a 16 year period, the Theil and Gini indices for the healthcare resources distributions remained high. Among the healthcare workforce distributions, the Gini index (GI) was lowest for nurses plus midwives (GI=0.428, 95% CI 0.393 to 0.463) and highest for specialist doctors (SPDs) (GI=0.704, 95% CI 0.652 to 0.756). Inter-region inequality was the highest for SPDs (95.0%) and the lowest for health officers (53.8%). The GIs for hospital beds, hospitals and health centres (HCs) were 0.592(95% CI 0.563 to 0.621), 0.460(95% CI 0.404 to 0.517) and 0.409(95% CI 0.380 to 0.439), respectively. The interaction term was highest for HC distributions (47.7%). Outpatient department visit per capita (GI=0.349, 95% CI 0.321 to 0.377) and fully immunised children (GI=0.307, 95% CI 0.269 to 0.345) showed inequalities; inequality in the under 5 years of age mortality rate increased overtime (P=0.048). Overall, GI for government health expenditure (GHE) was 0.596(95% CI 0.544 to 0.648), and the estimated relative GHE share of the healthcare workforce and infrastructure distributions were 46.5% and 53.5%, respectively. The marginal changes in the healthcare resources distributions were towards the advantaged populations.ConclusionThis study revealed high inequalities in healthcare resources in favour of the advantaged populations which can hinder equal access to healthcare and the achievements of healthcare outcomes. The government should strengthen monitoring mechanisms to address inequalities based on the national healthcare standards.