Health Care Patterns and Planning in Developing Countries

By Rais Akhtar | Go to book overview

7
Health Services Development, Illness and Health Behavior in Ethiopia

HELMUT KLOOS, ALEMAYEHU ETEA, ASSEFA DEGEFA, HUNDESSA AGA, BERHANU SOLOMON, KABEDE ABERA , ABEBE ABEGAZ, GETO BELEMO

Few comparative studies have been carried out on the prevalence of illness and on health behavior in urban versus rural areas in developing countries. Mortality is generally lower in urban areas, largely because of the higher socioeconomic level in city populations. 1 Within cities as well, there are great variations in health levels and in accessibility to medical care among different residential and socioeconomic groups, particularly in free enterprise societies. The well-known urban bias in health services provision in developing countries, widespread use of city services by rural populations and the existence of various forms of medical pluralism provide a fertile ground for comparative health research. 2 Whereas problems in urban health development are more often linked with faster population growth than resource allocation 3 and rural health problems with the chronic shortage of modern services and the cultural lag, both urban and rural health are strongly affected by broadly based underdevelopment. Few urban/rural health studies have been undertaken in socialist countries within the developing world, particularly in Africa, and only one in Ethiopia. 4

The few studies of health services utilization in rural Ethiopia available have reported on geographic, economic and cultural barriers between patients and care, on inefficient patient referral and the related influx of many self-referred patients to health facilities in Addis Ababa, and on the widespread use of traditional medicine. 5 Kloos et al. 6 noted a steep distance decay in utilization in both the capital city and in five administrative regions. In order to evaluate the performance of the health care system and to plan services in the future, the Ministry of Health requires information about both the health status and the health behavior of the urban and rural communities it serves. Specific areas of

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