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    Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines.

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    Author
    Hodge, A; Firth, S; Bermejo, R; Zeck, W; Jimenez-Soto, E
    Date
    2016-07-06
    Source Title
    BMC Public Health
    Publisher
    Springer Science and Business Media LLC
    University of Melbourne Author/s
    Firth, Sonja
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Hodge, A., Firth, S., Bermejo, R., Zeck, W. & Jimenez-Soto, E. (2016). Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines.. BMC Public Health, 16 (1), pp.523-. https://doi.org/10.1186/s12889-016-3148-0.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253690
    DOI
    10.1186/s12889-016-3148-0
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936303
    Abstract
    BACKGROUND: Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving the wealth-based utilisation gap. METHODS: Using national representative data from the 2013 Philippines Demographic and Health Survey, we examine the extent overall differences in the utilisation of maternal health services can be explained by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-based delivery. RESULTS: The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by differences in observed characteristics. After controlling for factors characterising the socioeconomic status of the household (i.e. the mothers' and her partners' education and occupation), the birth order of the child was the major factor contributing to the disparity. Mothers' religion and the subjective distance to the health facility were also noteworthy. CONCLUSIONS: This study has found moderate wealth-based disparities in the utilisation of institutional delivery in the Philippines. The results confirm the importance of recent efforts made by the Philippine government to implement equitable, pro-poor focused health programs in the most deprived geographic areas of the country. The importance of addressing the social determinants of health, particularly education, as well as developing and implementing effective strategies to encourage institutional delivery for higher order births, should be prioritised.

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