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How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal

Parmar, D. ORCID: 0000-0002-7979-3140 and Banerjee, A. ORCID: 0000-0001-8961-7223 (2019). How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal. Social Science & Medicine, doi: 10.1016/j.socscimed.2019.112582

Abstract

The launch of the Millennium Development Goals in 2000, followed by the Sustainable Development Goals in 2015, and the increasing focus on achieving universal health coverage has led to numerous interventions on both supply- and demand-sides of health systems in low- and middle-income countries. While tremendous progress has been achieved, inequities in access to healthcare persist, leading to calls for a closer examination of the equity implications of these interventions. This paper examines the equity implications of two such interventions in the context of maternal healthcare in Senegal. The first intervention on the supply-side focuses on improving the availability of maternal health services while the second intervention, on the demand-side, abolished user fees for facility deliveries. Using three rounds of Demographic Health Surveys covering the period 1992 to 2010 and employing three measures of socioeconomic status (SES) based on household wealth, mothers' education and rural/urban residence – we find that although both interventions increase utilisation of maternal health services, the rich benefit more from the supply-side intervention, thereby increasing inequity, while the poor benefit more from the demand-side intervention i.e. reducing inequity. Both interventions positively influence facility deliveries in rural areas although the increase in facility deliveries after the demand-side intervention is more than the increase after the supply-side intervention. There is no significant difference in utilisation based on mothers’ education. Since people from different SES categories are likely to respond differently to interventions on the supply- and demand-side of the health system, policymakers involved in the design of health programmes should pay closer attention to concerns of inequity and elite capture that may unintentionally result from these interventions.

Publication Type: Article
Additional Information: © Elsevier 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Publisher Keywords: Senegal; Exemption; Quality of care; EquityMaternal health; Access; Emergency obstetric care; User fees
Subjects: D History General and Old World > DT Africa
R Medicine > RG Gynecology and obstetrics
Departments: School of Health Sciences > Healthcare Services Research & Management
URI: http://openaccess.city.ac.uk/id/eprint/22916
[img] Text - Accepted Version
This document is not freely accessible until 28 September 2020 due to copyright restrictions.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

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