Unit 6

Health service provision

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 Session Objectives

• Define equity of health care

• Differentiate Equity and Equality

• Appreciate the implications of equity in the health sector

• What is health utilization

• Determinants of health care utilization

• Domains of health service coverage

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 Equity possibly defined as:

• Justice according to natural law or right;

specifically: freedom from bias or favoritism.

• The state of quality of being justce, impartial, and

fair.

• Equity is an ethical principle and closely related to

human rights.

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 What does ‘Equity’ in Health mean?

• Equity in health implies addressing differences

in health status that are:
– Unnecessary
– Avoidable and
– Unfair

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 What does ‘Equity’ in Health mean?

• Equity in health can be defined as the absence of

disparities in health that have social disadvantage

• The absence of differences in one or more aspects

of health across socially and economically defined
population groups.

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 Difference of inequality and inequity
 Health inequality: Differences or disparities in
health achievements of individuals or groups
 Health inequity:Those inequalities that are
considered to be unfair, injustice, avoidable or
unnecessary
 so, health inequity is the subset of health
inequalities that are unjust or unfair.
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• Equality is sameness and equity is fairness.

• Equal may not be equitable, or equal may be

precisely equitable.

• In some case unequal may be a way to be

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equitable.
 Dimension of equity

• Horizontal Equity: the allocation of equal or

equivalent resources for equal need; persons with
same ability to pay make same contributions;

• Vertical Equity: the allocation of different resources

for different levels of need; persons with unequal
ability to pay make dissimilar contributions;

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 Dimension of equity…

• If two individuals are in fact unequal in

capacity, equal treatment would be unfair to
the more capable of the two.

• In such case, equity might call for un equal

treatment

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 Health care utilization and coverage
What is utilization?

• Utilization is when the individual actually acts

on his demand or need and receives health
services
 Determinant factors of Health care utilization
• Anderson model: three factor

1. Predisposing factor
 Knowledge, attitude, values, belief, etc

2. Enabling factor

 Availability, accessibility and acceptability

of service,
3. Need factor
 Perception of severity, days missed from work
 Determinants of heath care utilization

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 The 4 A’s Model
1. Availability
 Demographic distribution of health facility

2. Accessibility
 Transport and road, etc

3. Affordability
 Treatment coast, direct, indirect coasts

4.Acceptability
 Health Service Coverage

 What is Health Service Coverage

 What are the domains of Health Service

Coverage
 Health Service Coverage…
 Health Service Coverage is considered as a
concept expressing the extent of interaction
between the service and the people for whom it
is intended

The ratio between the number of people for whom

the condition is met and the target population,
 Health Service Coverage

 Limiting the target population to specific

subgroups differentiated by certain conditions
or by demographic or socio- economic factors.
 Health Service Coverage…
 WHO proposes five domains of coverage measure
:

1. Availability coverage

2. Accessibility coverage

3. Acceptability coverage

4. Contact coverage

5. Effective coverage
 Health Service Coverage …
1. Availability coverage

 First of all, some resources – human power, facilities,

drugs, etc- are always required in order to provide a
service,

The ratio between this resources and the size of the

target population gives the measurement of
availability coverage
 Health Service Coverage …
2.Accessibility coverage

 The service must be located within reasonable

reach of the people who should benefit from it.

 Meeting this condition can be considered as the

next stage in the process of service provision,

 Here , the capacity of the service is limited by

the number of people who can reach and use it.
 Health Service Coverage …
3.Acceptability coverage

 The service needs to be acceptable to the

population, otherwise people may not use it

 This “acceptability” may be influenced by such

factors as the cost of the service, religion, etc.

 Here service capacity is limited by the number of

people who are willing to use the service.

 Quality is most closely related to acceptability .

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 Health Service Coverage …
4. Contact Coverage

 The next stage in the process of service provision

is the actual contact between the service provider
and the user.

 The ratio between number of people who have

contacted and the size of the target population
gives measurement of contact coverage.

 Utilization is related to contact coverage.

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 Health Service Coverage …
5.Effectiveness coverage

 The contact between the service provider and the user does not
always guarantee a successful intervention related to the user’s
health problem or an effective service.

 We can, therefore, consider another stage in the process of

service provision where a service performance that is appraised
as satisfactory by specific criteria is achieved.

 The number of people who have received satisfactory service is

thus another measurement of service output called effective
coverage.
 Coverage..
A. Potential coverage
Availability coverage
Accessibility coverage
 Acceptability coverage

B. Actual coverage
Contact coverage
Effectiveness coverage
Thank you!