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How equitable is health spending on curative services and institutional delivery in Malawi ? Evidence from a quasi-longitudinal benefit incidence analysis

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dc.creator Rudasingwa, M.
dc.creator Yeboah, E.
dc.creator /Ridde, Valéry
dc.creator /Bonnet, Emmanuel
dc.creator De Allegri, M.
dc.creator Muula, A. S.
dc.date 2022
dc.date.accessioned 2022-04-27T17:37:55Z
dc.date.available 2022-04-27T17:37:55Z
dc.identifier https://www.documentation.ird.fr/hor/fdi:010084356
dc.identifier oai:ird.fr:fdi:010084356
dc.identifier Rudasingwa M., Yeboah E., Ridde Valéry, Bonnet Emmanuel, De Allegri M., Muula A. S.. How equitable is health spending on curative services and institutional delivery in Malawi ? Evidence from a quasi-longitudinal benefit incidence analysis. 2022, 21 (1), p. 25 [12 p.]
dc.identifier.uri http://biblioteca-repositorio.clacso.edu.ar/handle/CLACSO/169167
dc.description Background Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. Understanding the distributional impact of health spending over time due to these policies has received limited attention. Our study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016. Methods We relied on a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. We used data from household surveys and National Health Accounts. We used a concentration index (CI) to determine the health benefits accrued by each socioeconomic group. Results Socioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. Between 2004 and 2016, the inequality in public spending on curative services decreased from a CI of 0.037 (SE 0.013) to a CI of 0.004 (SE 0.011). Whiles, it decreased from a CI of 0.084 (SE 0.014) to a CI of 0.068 (SE 0.015) for overall spending in the same period. For institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a CI of 0.032 (SE 0.028) to a CI of -0.057 (SE 0.014) and from a CI of 0.036 (SE 0.022) to a CI of 0.028 (SE 0.018), respectively. Conclusions Through its free healthcare policy, Malawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. Our findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection.
dc.language EN
dc.subject Benefit incidence analysis
dc.subject health spending
dc.subject inequality
dc.subject health care
dc.subject utilization
dc.subject Malawi
dc.title How equitable is health spending on curative services and institutional delivery in Malawi ? Evidence from a quasi-longitudinal benefit incidence analysis
dc.type text
dc.coverage MALAWI


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