Inequalities in Access to Health Care in Brazil and India Closing the Gap for the Poorest-poor

1
Inequalities in Access to Health Care in Brazil
and IndiaClosing the Gap for the Poorest-poor
ESRC Collaborative Analysis of Micro Data
Resources BRAZIL-INDIA PATHFINDER Research
Project
Sabu Padmadas (ssp_at_soton.ac.uk) 4th ESRC
Research Methods Festival, St. Catherines
College, University of Oxford, 5-8 July, 2010
2
life expectancy at birth, 1950-2050
Source of data calculated from the UN World
Population Prospects, 2008 revision
(http//esa.un.org/unpp/)
3
Source Marmot Review (2010) Fair Society,
Healthy Lives http//www.ucl.ac.uk/gheg/marmotrevi
ew/Documents/finalreport
4
Source Marmot Review (2010) Fair Society,
Healthy Lives http//www.ucl.ac.uk/gheg/marmotrevi
ew/Documents/finalreport
5
objectives of the project

• Facilitate international research
  partnerships and networking of social
  scientists from Brazil, India and the UK
• Analyse large-scale national survey data to
  address policy-oriented research problems in the
  area related to social inequalities and
  population health
• Share research experiences and build
  capacity in quantitative analysis of health and
  demographic data from household surveys
• Produce joint academic research outputs and
  disseminate findings at international conferences
• Identify priority research areas and
  strengthen the research consortium by developing
  joint research proposals.

6
research Team UK partners

• Sabu Padmadas, Andrew Channon, Fiifi Amoako
  Johnson, Zoe Matthews, Maria Evandrou, Jane
  Falkingham
• Saseendran Pallikadavath Tiziana Leone
• Expertise Reproductive and child health, Family
  planning, Health care systems, Health
  inequalities, Epidemiology, Poverty, Ageing,
  Spatial analysis, Survey data analysis,
  Demographic Health Surveys

7
research Team Brazil

• André Junqueira Caetano, Eduardo L.G. Rios-Neto,
  Carla Jorge Machado, Ernesto F. L. Amaral,
  Monica Viegas Kenya Noronha
• Expertise Reproductive and child Health, Family
  planning, Economic demography, Health Economics,
  Epidemiology, Policy evaluation, Health care
  systems, Health inequalities Infectious diseases,
  Poverty, Ageing, Demographic Health Surveys

8
research Team India

• KS James, Lekha Subaiya
  
• Dilip TR (currently based in Abhishek
  Singh Family Health International-New
  Delhi), US Mishra
• Expertise Reproductive and child Health, Health
  inequalities, Economic demography, Health care
  systems, Health inequalities, Morbidity, Poverty,
  Ageing, Demographic Health Surveys, National
  Sample Surveys

9
Brazil-India the case for comparison

• steady economic growth, increase in
  per-capita income
• working age population and demographic
  dividend
• extreme inequalities (wealth, health,
  education)
• growing urban poverty, rich-poor gap
  widening
• rise of middle-class (crushed in-between
  rich-poor)
• increased desire for small families and FP
  use patterns
• differential health systems policies,
  common health
• goals

10
research questions (1)

• What are the assessment criteria to
  measure and quantify inequalities in health care
  access in Brazil and India?
• What is the extent of inequalities in
  access to health care and how do these vary over
  time and within (intra) and across (inter) wealth
  and expenditure classes and by geographical
  location of residence?
• What are the individual, household and
  community barriers to health care access and how
  these differ between Brazil and India?

11
research questions (2)

• How do individual, household and community
  attributes interact and mediate the relationship
  between household wealth and health care access?
• What is the extent of heterogeneity in
  health care access at the community level?
• To what extent do differences in
  inequalities in access to health care between
  Brazil and India reflect differences in health
  care system functioning and policies and whether
  they have narrowed or widened the gap between the
  rich and the poor?

12
conceptual framework
Life course component of health care, focusing on
three population sub-groups Children below 5
years, women in the reproductive age range
(15-49) and older women aged 60
13
Timeline Outputs

• 12 months (April 2010 March 2011)
• Three sets of research workshops with specific
  research agenda incl academic papers (under
  progress), research proposals and capacity
  building activities June 2010 (Belo Horizonte),
  Jan 2011 (Bangalore) Mar 2011 (Southampton).
• Dissemination national and international
  conferences, project website, fact sheets,
  peer-reviewed joint publications

14
Brazil workshop, 28 June 2 July, 2010
15
Identified 6 key comparative analyses

• PAPER 1 (Leone et al)
• Health systems and inequalities in India and
  Brazil How do they cope?
• PAPER 2 (Caetano et al)
• Social inequality, health care delivery system
  and family planning in Brazil and India
  drugstore, hospital or public policy (an
  APC-hierarchical approach)?
• PAPER 3 (Amaral et al)
• Quantifying child health care inequalities in
  poor settings the case of India and Brazil

16

• PAPER 4 (Channon et al)
• Use of inpatient health care for the elderly in
  Brazil and India
• PAPER 5 (Padmadas et al)
• Inequalities in access to modern contraception in
  India and Brazil
• PAPER 6 (Pallikadavath et al)
• Access to reproductive health care services among
  the poorest-poor in India- a multilevel modelling
  in India and Brazil
• stand alone country specific papers

17
Micro data resources used

• Brazil
• Pesquisa Nacional de Demografia e Saúde (PNDS),
  1986, 1991, 1996
• National Household Sample Survey (PNAD), 1998,
  2003, 2008
• Avaliação de Impacto do Programa Bolsa Família
  (AIBF), 2005
• Pesquisa de Orçamentos Familiares (POF), 2002-03,
  2007-08
• Sistema de Informações sobre Mortalidade (SIM),
  several, ongoing
• Sistema de Informações de Nascimentos (SINASC),
  several, ongoing
• Sistema de Informações Hospitalares (SIH),
  several, ongoing
• Sistema de Informações do Atendimento Básico
  (SIAB), several, ongoing
• India
• National Family Health Survey (NFHS), 1992-93,
  1998-99, 2005-06
• National Sample Survey Organization (NSSO),
  1986-87, 1995-96, 2004-05
• Reproductive and Child Health Surveys (DLHS),
  1998-99, 2002-04, 2006-07
• WHO Study on Global Ageing and Adult Health
  (SAGE), 2003, 2007

18
Administrative units (spatial level)
Brazil Índia
5507 Municipalities Village/Ward/Town
558 Micro regions 640 Districts
137 Meso regions
27 States 31 States
5 Major regions 6 Major Regions
19
ratio (richest-fifth over poorest-fifth)
Current contraceptive use among women aged 25
years or above who have 2 or more children
Analysis of the 2005/06 National Family Health
Surveys, India (analyses under progress, Padmadas
et al.)
20
odds ratio of antenatal care uptake
Analysis of the 2007/08 District Level Household
Survey (analyses under progress, Pallikadavath et
al.)
21
social ladder and targeted interventions
Distribution of women by caste and household
wealth in India
Analysis of the 2005/06 National Family Health
Surveys, India
22
acknowledgments

• ESRC/Pathfinder Scheme (Grant Reference
  RES-238-25-0009)
• Project team members from Brazil, India the
  UK
• Thank you very much