Utilisation of Health Services and Geography: Deconstructing Regional Differences in Barriers to Facility-Based Delivery
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Utilisation of Health Services and Geography: Deconstructing Regional Differences in Barriers to Facility-Based Delivery in Nepal Andrew Hodge • Abbey Byrne • Alison Morgan Eliana Jimenez-Soto
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Ó Springer Science+Business Media New York 2014
Abstract While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder– Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers’ education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers’ birth history was also noteworthy.
A. Hodge (&) E. Jimenez-Soto School of Population Health, The University of Queensland, Public Health Building, Herston Road, Herston, QLD 4006, Australia e-mail: [email protected] A. Byrne A. Morgan The Nossal Institute for Global Health, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3010, Australia
Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas. Keywords Facility-based delivery care Regional coverage gaps Geographic inaccessibility Decomposition Nepal
Introduction In order to achieve universal coverage, the so-called third global health transition [1], policy and program responses must address the major barriers to the use of essential health services. While both supply and demand-side barriers coexist, it remains unclear to what degree each contribute to low levels of utilisation. It remains unknown, therefore, whether scarce resources should be invested on building, equipping and staffing new facilities, on the premise that if you build them then people will come, or whether those resources should be directed to programs influencing health behaviours related to the demand of health services. Geography imposes serious constraints on the delivery of health services in many
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