Achieving equity by way of improving the condition of the economically
poor or otherwise disadvantaged is among the core goals of contemporary
development paradigm. This places importance on monitoring outcome
indicators among the poor. National surveys allow disaggregation of
outcomes by socioeconomic status at national level and do not have
statistical adequacy to provide estimates for lower level administrative
units. This limits the utility of these data for programme managers to
know how well particular services are reaching the poor at the lowest
level. Managers are thus left without a tool for monitoring results for
the poor at lower levels. This paper demonstrates that with some extra
efforts community and facility based data at the lower level can be used
to monitor utilization of healthcare services by the poor.
Data used in this paper came from two sources- Chakaria Health and
Demographic Surveillance System (HDSS) of ICDDR,B and from a special
study conducted during 2006 among patients attending the public and
private health facilities in Chakaria, Bangladesh. The outcome variables
included use of skilled attendants for delivery and use of facilities.
Rate-ratio, rate difference, concentration index, benefit incidence
ratio, sequential sampling, and Lot Quality Assurance Sampling were used
to assess how pro-poor is the use of skilled attendants for delivery and
Poor are using skilled attendants for delivery far less than the better
offs. Government health service facilities are used more than the
private facilities by the poor. Benefit incidence analysis and
sequential sampling techniques could assess the situation realistically
which can be used for monitoring utilization of services by poor. The
visual display of the findings makes both these methods attractive.
LQAS, on the other hand, requires small fixed sample and always enables
With some extra efforts monitoring of the utilization of healthcare
services by the poor at the facilities can be done reliably. If
monitored, the findings can guide the programme and facility managers to
act in a timely fashion to improve the effectiveness of the programme in
reaching the poor.
International Journal for Equity in Health (2009), 8:29 [doi:10.1186/1475-9276-8-29]
Three methods to monitor utilization of healthcare services by the poor.