Socio-economic and spatial trends in child and maternal health care inequalities in Cameroon: a uni- and multidimensional analysis

Abstract

In developing economies, a number of investigations have highlighted the fact that the increase in health expenditure will only contribute to poverty reduction if such expenditure is efficient and if access to health services becomes more equitable. This paper measured inequality trends in maternal and child health services access and use based on socioeconomic and regional characteristics in Cameroon where health policies were redirected in the 90s with more focus on the improvement of equity.

Methods: Using data from Demographic and Health Surveys (1991, 1998 and 2004), the relationship between socio-economic status (SES) and health inequalities was assessed. Concentration Index (CI) and an accurate estimate built from the capability theory were used to measure inequality trends in SES by regions and regional disparities in terms of health services provision, utilization, and outcomes.

Results: The relevant policies and interventions have been more effective in reaching the better-off than the worst-off. Increase in total health care access and use were detected for both variables (immunization - three DPT -, and assistance at delivery by a trained attendant) with CIs showing improved movements through equal distribution. This observation was contradicted by Lorenz curve for assistance at delivery. Trend differentials observed from capability-based health index reveal a significant correlation between health outcomes, deprivation and geographic affiliation.

Conclusions: Maternal and child health services access and use are determined by both socio-economic status (household wealth) and a number of factors including governance (resource allocation) and contextual factors (geographic and socio-cultural). In such context, improvements in the monitoring of health care distribution is important to be carry out at both national and sub-national levels, especially in developing countries that have undergone decentralization and where socio-cultural factors may greatly differ from one region to another.