Malawi Health Equity Report 2011
Inequality and health in Malawi 2011 – an analytical study identifying trends over 19 years
George Chapotera1 and Cameron Bowie2
1: Department of Planning, MOH
2: Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
October 2011
Prepared for the Technical Working Group on health equity
Ministry of Health and SWAp partners
Abstract
Background
Malawi is the eleventh poorest country in the world according to UNDP (HDR2010). Health affects poverty and poverty affects health. This paper considers the contribution inequity of health care plays to the health status in Malawi over 19 years from 1992 to the present time..
Methods
Published data prepared by the World Bank and the Malawi Integrated Household Surveys are augmented by analysis of Demographic and Health and Multiple Indicator Cluster Surveys including the latest DHS 2010 survey. Inequalities are identified and quantified using asset scores, wealth quintiles and the equality index – a measure of inequality.
Results
There has been a substantial and enduring improvement in the levels of equality for indicators of health status and the use of health services. Where access is universal, such as EPI, antenatal care and the treatment of pneumonia, the indicators are highly equitable. Where access is improving but not yet universal for services such as skilled birth attendance, family planning and bed net usage the equality indices demonstrate some progress has occurred but show room for further improvement. Underlying determinants offer a mixed picture – some show more inequality such as with fertility and women’s empowerment and some more equality, such as orphan-hood.
Conclusions
Poverty in all its facets is a key underlying cause of ill health in Malawi. Recent efforts to improve access to health care through the Essential Health Package have tended to reduce inequalities. Patience and persistence appears to be having an effect on many of
George Chapotera1 and Cameron Bowie2
1: Department of Planning, MOH
2: Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
October 2011
Prepared for the Technical Working Group on health equity
Ministry of Health and SWAp partners
Abstract
Background
Malawi is the eleventh poorest country in the world according to UNDP (HDR2010). Health affects poverty and poverty affects health. This paper considers the contribution inequity of health care plays to the health status in Malawi over 19 years from 1992 to the present time..
Methods
Published data prepared by the World Bank and the Malawi Integrated Household Surveys are augmented by analysis of Demographic and Health and Multiple Indicator Cluster Surveys including the latest DHS 2010 survey. Inequalities are identified and quantified using asset scores, wealth quintiles and the equality index – a measure of inequality.
Results
There has been a substantial and enduring improvement in the levels of equality for indicators of health status and the use of health services. Where access is universal, such as EPI, antenatal care and the treatment of pneumonia, the indicators are highly equitable. Where access is improving but not yet universal for services such as skilled birth attendance, family planning and bed net usage the equality indices demonstrate some progress has occurred but show room for further improvement. Underlying determinants offer a mixed picture – some show more inequality such as with fertility and women’s empowerment and some more equality, such as orphan-hood.
Conclusions
Poverty in all its facets is a key underlying cause of ill health in Malawi. Recent efforts to improve access to health care through the Essential Health Package have tended to reduce inequalities. Patience and persistence appears to be having an effect on many of
References: 1. National Statistics Office (NSO) [Malawi], OCR Macro (2011) Malaŵi Demographic and Health Survey 2010. Calverton, Maryland: NSO and Macro. p. 2. Chapotera G, Sabola B, Nkhoma D (2009) Inequality and health in Malawi 2009 – an analytical study identifying trends over 17 years. Lilongwe, Malawi: Ministry of Health. p. 3. National Statistics Office (NSO) [Malawi] (2006) Integrated Household Survey 2004/05. Zomba, Malawi. p. Available: http://www.nso.malawi.net/index.php?option=com_content&view=article&id=79&Itemid=63. Accessed 24 Oct 2011. 5. Rutstein Shea O, Johnson K (2004) The DHS wealth index. DHS Comparative Reports 6. 7. Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A (2009) Agbessi Amouzou.(2007)“Socio-Economic Differences in Health, Nutrition, and Population: Malawi”, Country Reports on HNP and Poverty, Washington, DC: World Bank. p. 8. Wagstaff A, Paci P, van Doorslaer E (1991) On the measurement of inequalities in health. Soc Sci Med 33: 545-557. 9. Wagstaff A (2005) The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ 14: 429-432. doi:10.1002/hec.953 10 11. National Statistics Office (NSO) [Malawi], OCR Macro (2005) Malaŵi Demographic and Health Survey 2004. Calverton, Maryland: NSO and Macro. p. 12. Office MNS, UNICEF (n.d.) Malawi Multiple Indicator Cluster Survey (MICS), 2006. Monitoring the situation of children and women. Preliminary report. Monitoring the Situation of Children and Women. 13. Benson T (2001) Profile of poverty in Malawi, 1998. National Economic Council-International Food Policy Research Institute (IFPRI), Washington, USA. 15. Zere E, Moeti M, Kirigia J, Mwase T, Kataika E (2007) Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health 7: 78. doi:10.1186/1471-2458-7-78 16