Health care utilization and coverage
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Contents
o What is health utilization
o Determinants of health care utilization
o Health providers
o Indicators of health service utilization
o Domains of health service coverage
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What is utilization?
Utilization is when the individual actually acts
on this demand or need and receives health
services
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Health care utilization
• Anderson model: three factor
1. Predisposing factor
Knowledge, attitude, values =,belief, age, education, etc
2. Enabling factor
Availability of service, financial resource, social support
3. Need factor
Perception of severity, days missed from work
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Determinants of heath care utilization
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The 4 A’s Model
1. Availability
Demographic distribution of health facility, Pharmaceutical
products
2. Accessibility
Transport and road, etc
3. Affordability
Treatment coast, direct, indirect coasts
[Link]
Relates to cultural and social distances
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Health service providers in Ethiopia
1. Traditional or indigenous system
2. Private sectors and NGOs
[Link] public health services
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1. Ethiopian traditional medical system
Typologies( Molvaer’s Typology)
[Link]: scrolls digimits
Pure magic is quite common
2. Astronology_ Reading stars( Meret, Ayer, wiha)
The principle here is the once course of life is fixed when
the fetus of forty days
3.Naturalistic__Herbs, holy water, wagesha, and birth
attendants
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Relevance of traditional medicine to modern medicine
A. Ancillary role : Integrating inexpensive means of
service expansion (TBA)
To complement of the curing service of modern
medicine by healing of traditional means where
simultaneous resort exist
B. Active role : Integrating traditional healers in
clinical setting.
Healing dealing with psychiatric patients
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Challenges
1. National policy are not always implementing
2. Pouching of the evaluative finding regarding the effective finding of
the traditional medicine
3. Poor performance of national PHC
4. Cultural gap b/n the modern and the traditional medicine
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The way forward
[Link]? Not possible operationalize them
2. Ignoring them(At least officially)
3. Non formal recognition and occasional cooperating with
them
4. Formal recognition at their place
[Link] and registration
6. Recruiting and training for partial integration
[Link] integration(Far east experience??)
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[Link] sector and NGO
Role of private sector in health
1. Increased accessed to health care
2. Expand resource of health care
3. Increase over all efficiency by permitting
government to take advantage of efficiency gains
by private sector
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Private sector
Potential advantage Potential problem
• Efficiency o Supplier induced demand
o Less waiting time o Low quality of service and
o Better access possibility of malpractice
• Perceived better quality o Failure to promote equity
o Longer and flexible hours o Exodus of professionalism
o Better consumer services
o Availability of qualified staff
o Better availability of drugs and suppliers
o Confidentiality
o Better technology
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NGO
• Types of NGO
1. High specialized non profit consultancy
services firms
[Link] international NGO which are accustomed
in implementing large scale development
project
3. Indigenous voluntary organization
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Advantages of NGO
[Link] to the periphery and the poor
[Link] responding to the local need
[Link] and committed staff
[Link] resource are mainly additional
[Link] skill and experience in participatory development
[Link] may entrusted to provide services with dominant
public health
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How income affect health provider selection?
• Even though mixed findings are reported many studies agreed that,
people who have high income more prefer private health care
services provider,
• The choice of health care provider is much more sensitive to price for
low income groups of patients than for higher income groups and this
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Health utilization indicators
• Facility based
– Hospital admission
– Patient-day
– Length of stay
– Nursing home admission
– Other facility indictors [hospital emergency rooom, hospital out
patient, free standing emergency room…]
• Individual based
– Physician utilization
– Utilization of other health personnel
– Treatment rate
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Health Service Coverage
What is Health Service Coverage
What are the domains of Health Service Coverage
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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
This interaction not being limited to particular aspect of service
provision but,
Ranging over the whole process from resource allocation to
achievement of the desired objective.
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Health Service Coverage
For the measurement of coverage, several key stages
are first identified, and
Each of them involving the realization of an important
condition for providing the service.
A coverage measure is then defined for each stage,
namely,
The ratio between the number of people for whom the
condition is met and the target population,
So that a set of these measures represents the
interaction between the service and the target
population.
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Health Service Coverage
This definition of coverage allows for variations, which
are called “specific coverage”
limiting the target population to specific subgroups
differentiated by certain conditions related to service
provision or by demographic or socio- economic
factors.
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Health Service Coverage
The evaluation of coverage on the basis
of these concepts enables management
to
To identify bottlenecks in the operation of the
service,
To analyze the constraining factors
responsible for such bottlenecks, and
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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 23
Health Service Coverage
[Link] coverage:
First of all, some resources – human power, facilities, drugs,
etc- are always required in order to provide a service,
the availability of such resources limits the maximum capacity
of the service , which in turn decides the amount of the service
that can be made available to the target population.
The ratio between this capacity and the size of the target
population gives the measurement of availability coverage
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Health Service Coverage
[Link] 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.
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Health Service Coverage
[Link] coverage:
Once the service is accessible, it still needs to be acceptable to
the population, otherwise people may not come for it and may
even seek alternative care.
This “acceptability” may be influenced by such factors as the cost
of the service to the user, the form of religion he follows, etc.
If the service is accepted by potential user, this is another step
forward in the process of service provision.
Here service capacity is limited by the number of people who are
willing to use the accessible 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 number of people who have contacted the service is a
measurement of service output, the ratio between this 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
[Link] 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.
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Health Service Coverage
A. Potential coverage
Availability coverage
Accessibility coverage
Acceptability coverage
B. Actual coverage
Contact coverage
Effectiveness coverage
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Take-home assignment
• What is the potential primary health
coverage
• How it is calculated ?
• What is the health utilization rate in our
country?
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THANK YOU
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