Health Care Patterns and Planning in Developing Countries

By Rais Akhtar | Go to book overview

TREATMENT OUTCOME

Relatively low proportions (22.2 to 26.5 percent) of patients in the various treatment categories claimed to have been cured. ILL persons who took no action even reported a somewhat higher cure rate (27.8 percent). These patterns reflect to a great extent normative health behavior in Ethiopia, which is characterized by (1) a wait-and-see attitude in the case of most mild and transitory illnesses; (2) the tendency of many people to delay the trip to modern health services until all other health resources have been explored and disease is exacerbated; and (3) use of over-the-counter drugs for self-treatment at home of self-diagnosed illness, as well as the low efficacy of most rural health services. The high expectations Ethiopians have of modern health services may have further depressed the perceived cure rate from modern care.


COVERAGE

Coverage by the modern health services was assessed using the norm of 2.5 visits per person per year as suggested by King54 for developing countries, which was adopted by Ethiopia's Ten-Year Health Plan. 55 By considering the number of both acute and chronic illnesses within their respective study periods, 1.9 contacts were calculated for Kaliti, 1.4 and 1.3 contacts for the low and high socioeconomic kebele in Addis Ababa, respectively, and 0.6 contacts for the rural villages. In view of the higher illness prevalence in the poor kebele in Addis Ababa (24 percent) than in the affluent kebele (16 percent) and relatively more widespread underreporting in the poor kebele, it can be concluded that utilization rates are still significantly higher in the affluent communities. The per capita utilization rates reported here for the urban kebele are higher and those for the rural communities lower than those reported from a small town in northern Ethiopia (1.2 contacts). 56 This pattern is in agreement with observed urban/rural gradients in health services allocation and socioeconomic level of the population. Thus, while coverage by the modern health services in the rural communities is still at a low level within the context of the Ten-Year Plan, it has reached intermediate levels in some urban neighborhoods. However, in the absence of baseline data, it is not known to what extent coverage in the urban areas has increased since the revolution.


CONCLUSIONS

The prevalence of illness and the utilization of health services in Addis Ababa and rural central Ethiopia are similar to those in many other developing countries. Although the socialist government has embarked on an ambitious health development program that has increased health services utilization, problems of program implementation and accessibility remain. In addition to geographic, socioeconomic and cultural barriers between patients and health services, unequal

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