Socio-economic status and health care utilization in rural Zimbabwe: findings from Project Accept (HPTN 043)

Abstract

Zimbabwe’s HIV epidemic is amongst the worst in the world, and disproportionately effects poorer rural areas. Access to almost all health services in Zimbabwe includes some form of cost to the client. In recent years, the socio-economic and employment status of many Zimbabweans has suffered a serious decline, creating additional barriers to HIV treatment and care. We aimed to assess the impact of i) socio-economic status (SES) and ii) employment status on the utilization of health services in rural Zimbabwe. Data were collected from a random probability sample household survey conducted in the Mutoko district of north-western Zimbabwe in 2005. We selected variables that described the economic status of the respondent, including: being paid to work, employment status, and SES by assets. Respondents were also asked about where they most often utilized healthcare when they or their family was sick or hurt. Of 2,874 respondents, all forms of healthcare tended to be utilized by those of high or medium-high SES (65%), including private (65%), church-based (61%), traditional (67%), and other providers (66%) (P=0.009). Most respondents of low SES utilized government providers (74%) (P=0.009). Seventy-one percent of respondents utilizing health services were employed. Government (71%), private (72%), church (71%), community-based (78%) and other (64%) health services tended to be utilized by employed respondents (P=0.000). Only traditional health services were equally utilized by unemployed respondents (50%) (P=0.000). A wide range of health providers are utilized in rural Zimbabwe. Utilization is strongly associated with SES and employment status, particularly for services with user fees, which may act as a barrier to HIV treatment and care access. Efforts to improve access in low-SES, high HIV-prevalence settings may benefit from the subsidization of the health care payment system, efforts to improve SES levels, political reform, and the involvement of traditional providers.

Utilization of health services in a resource-limited rural area in Kenya: prevalence and associated household-level factors

“…Addressing these determinants will require a multisectoral approach between the county government, development partners and other stakeholders. It was surprising that socio-economic status was not associated with utilization of health services as has been found elsewhere [19,20]. In our study, this was likely because our population was more or less homogeniously poorer than the rest of the country [9] and as such the socio-economic status determined using PCA may not clearly distinguish wealth groups in this population [14].…”

Global Health Diplomacy, ‘Smart Power’, and the New World Order

“…2013, AMFAR, 2013; and decreasing opportunities for opponents with destructive agendas (Jaffe, 2013) 2 Nation-building and peace-keeping initiatives: Contributions to nation-building (Kevany et al, 2012a) and peace-keeping processes (Eldon, Waddington, & Hadi, 2008;Kevany, 2012), including resolution of conflict (Novotny & Adams, 2007); regional stability (Feldbaum, 2010); integration of peace-building concerns into global health programmes (Novotny & Adams, 2007;Macrae, 1997;Kickbusch & Buss, 2011); and advancing democratisation in the developing world (AMFAR, 2013) 3 Strategic alignment: Harmonisation between bilateral and multilateral global health and foreign policies (CSIS, 2007;Feldbaum, 2010) and inculcation of strategic awareness of relationships between global health and foreign policy goals (CSIS, 2010), including recognition of the capacity of global health programmes to advance or obstruct international relations objectives (Katz et al, 2011) 4 'High-profile' conditions: Responding to health needs that may have significant implications for donor security, health or economic well-being (CSIS, 2010;Feldbaum, 2010), including transnational epidemic diseases such as HIV/AIDS, tuberculosis and malaria (Michaud & Kates, 2013) 5 Human rights: Alignment between global health service delivery and the defence and advancement of human rights, including the abolition of slavery, freedom from tyranny, and access to health services, thereby contributing to the advancement of human dignity, both within and beyond health (WHO, 2012) 6 Accessing strategic markets and resources: Optimising the extent to which global health programmes assist, in a manner that is fair and transparent to recipients, in gaining access to strategic resources or markets (Feldbaum, 2010), including commodity resources from lowand middle-income countries (AMFAR, 2013;Novotny & Kevany, 2013), which, in turn, generate economic gains for both donors and recipients (Jaffe, 2013) 7 Inclusiveness: Leveraging global health programmes to unite opposing political factions, promoting reconciliation and peace (Rubenstein, 2013), including negotiation, mediation and 'public health persuasion' initiatives, through integration of former adversaries within the same health service (Kickbusch, 2012) regardless of affiliation (Rubenstein, 2013) 8 Prestige: Leveraging global health programmes to re...…”

“…1 Neutrality: The selection of culturally, religiously and socially appropriate interventions (Kevany, 2012;Kevany, Hatfield, et al, 2012;Kevany, Khumalo-Sakutukwa, et al, 2012), encompassing vigilance around possible unanticipated consequences of global health programmes on recipient societies, cultures and religions (Adams, Novotny, & Leslie, 2008) 2 Visibility: Appropriate programmatic branding to generate positive associations between international presence, health outcomes, and donor prestige (Alesina & Dollar, 1998), thereby ensuring that (1) …”

Socioeconomic Status & Health Seeking Behavior of Rural People: A Cross Sectional Study in Fatikchhari, Chittagong

“…6 Low socioeconomic status is a common barrier to get health services for people and those direct and indirect factors are-doctor fees, cost of transport, medicine etc. 5 It is found from empirical studies from Bangladesh and few other countries that, socio-economic condition is considerable factors of health care seeking behavior for a community. 7 From this mentioned backdrops, it is necessary to understand the health seeking behavior and explore the socioeconomic determinants on this especially low economic community.…”

“…For instance, wealthier families are about twice time take health care service from formal and informal practitioners. 5 Socioeconomic factors including educational level, economic conditions, cultural beliefs, residence location etc. play a significant role to determine health care behavior of a community overall.…”