Inequities in healthcare seeking behaviour among the urban poor population, Bangladesh

In rapidly urbanising developing countries like Bangladesh evidence points towards a dichotomy in health status in urban non-slum areas and slum areas; the latter group experiences substantially worse health than even the... [ view full abstract ]

In rapidly urbanising developing countries like Bangladesh evidence points towards a dichotomy in health status in urban non-slum areas and slum areas; the latter group experiences substantially worse health than even the rural population. Furthermore, studies have reported much heterogeneity within slum populace in terms of wealth, and there exists a social-gradient of its own. In the effort to create more pro-poor health services, it is crucial to consider and address inequities in healthcare utilization within this group. The aim of this paper is to reveal the nuances of healthcare seeking with in this vulnerable population to assist the design of more equitable health services.

A cross sectional study was conducted on 1,037 and 1,046 respondents, suffering from acute and chronic health problems respectively. Ethical approval was obtained from icddr,b IRB. Outcome variables were “sought care”, “sought formal care” and “health expenditure as proportion of total”. Logistic regression was done to identify determinants of care seeking. Concentration index (CI) was used to measure inequity among socio-economic predictors that showed significant correlation in bivariate analysis.

Education, employment, and disease severity were significantly correlated with seeking formal healthcare. Females were more likely to seek formal care than males. Data also suggest significant regional variation, with industrial area dwellers seeking less care. In both disease types CI indcated inequity in service utilization and formal providers in favour of the wealthier households.

Disparities exist not only between slum and non-slum, but also along the continuum of the urban poor citizens; thus rich-poor generalizations should be used with reservation when planning health services. More granular disaggregation is warranted. These findings can aid the pathway to developmental goals such as “health and well-being for all” through thinking universal health coverage in a stratified and practical manner than taking generic approaches.