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Crossing the river: inequities in maternal health services in Cambodia

Crossing the river: inequities in maternal health services in Cambodia
Crossing the river: inequities in maternal health services in Cambodia
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.
University of Southampton
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b
Channon, Andrew
5a60607c-6861-4960-a81d-504169d5880c
Tzavidis, Nikolaos
431ec55d-c147-466d-9c65-0f377b0c1f6a

Nilsen, Kristine (2017) Crossing the river: inequities in maternal health services in Cambodia. University of Southampton, Doctoral Thesis, 297pp.

Record type: Thesis (Doctoral)

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.

Text
Crossing the River: Inequities in maternal health services in Cambodia - Version of Record
Restricted to Repository staff only until 28 January 2021.
Available under License University of Southampton Thesis Licence.

More information

Published date: January 2017

Identifiers

Local EPrints ID: 417787
URI: http://eprints.soton.ac.uk/id/eprint/417787
PURE UUID: d2038fa8-c060-4d3f-95cf-3cc8037e2bc5
ORCID for Andrew Channon: ORCID iD orcid.org/0000-0003-4855-0418
ORCID for Nikolaos Tzavidis: ORCID iD orcid.org/0000-0002-8413-8095

Catalogue record

Date deposited: 14 Feb 2018 17:30
Last modified: 24 Jul 2019 00:35

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