Crossing the river: inequities in maternal health services in Cambodia

Abstract

With the focus on universal health coverage (UHC) and the inclusion of an equity target in the newly adopted Sustainable Development Goals, equity analysis is becoming prominent in the evaluation of health policies in low-income countries. Focusing on Cambodia, the overall aim of this thesis is to examine spatial and socio-economic equity patterns in maternal health services between 2000 and 2014, a period characterised by extensive health systems reforms.

Inequities of maternal health services are examined on one UHC dimensions, population coverage in terms of use and quality of services. Using household surveys and the population census, inequities are measured using econometric analysis, logistic multilevel models and small area estimation. Results show that irrespective of residency, inequities in the use of services decrease over time as population coverage increases. However, use remains pro-rich in 2014. The pro-rich bias in urban areas is particularly strong when examining inequities of the quality of services received. In rural areas, inequities in quality by socio-economic status are low as most of the health services provided fail to meet the quality criteria applied. Moving beyond the urban/ rural dichotomy, large spatial inequities in the utilisation of services are for the first time observed at small areas, suggesting that health system characteristics and other socio-economic determinants manifest themselves geographically. Findings are discussed in the context of inverse equity hypothesis, health system reform and socio-economic development. The thesis concludes that there is partial support for the inverse equity hypothesis and that the hypothesis may have a spatial dimension that has previously not been captured. It also concludes that health system reforms targeting the supply-side of service provision probably had an effect on reducing inequities, but that socio-economic development including increased household wealth cannot be excluded as a major contributor to increased service uptake.

More information

Identifiers

ORCID for Kristine Nilsen: orcid.org/0000-0003-2009-4019

ORCID for Andrew Channon: orcid.org/0000-0003-4855-0418

ORCID for Nikolaos Tzavidis: orcid.org/0000-0002-8413-8095

Catalogue record

Export record