An Equity-Focused Approach to Health Services and Its Influence on Health-Seeking Behaviour Patterns in Peri-urban Communities: A Study of Matero, Lusaka, Zambia
Abstract:
Health equity remains a central concern in achieving universal health coverage in Zambia. Despite reforms such as the abolition of user fees and the introduction of the National Health Insurance Management Authority (NHIMA), disparities in healthcare access and utilisation persist. This study examined the influence of an equity-focused approach to health services on health-seeking behaviour among residents of Matero Township in Lusaka, Zambia. A cross-sectional comparative design using mixed methods was employed, involving 252 respondents from public and private health facilities. Findings revealed that while 58.3% of respondents reported access to healthcare services, 41.7% still lacked access, indicating persistent inequities. Systemic barriers were reported by 65.5% of participants, while 57.4% perceived inequalities in service delivery. Key determinants of health-seeking behaviour included distance to health facilities (25.6%), availability of medication (23.3%), and cost of services (22.0%). Although 70.4% expressed confidence in local health services, utilisation remained irregular. The study concludes that while equity-focused reforms have improved access, structural barriers continue to limit optimal utilisation.References:
[1].
Chansa
C. Zambia Health Sector Public Expenditure Review. Washington (DC): World Bank;
2018. doi:10.1596/31784.
[2].
Ministry
of Health Zambia. National Health Strategic Plan 2017–2021. Lusaka: Ministry of
Health; 2017.
[3].
Gao
W, et al. Care-seeking pattern for diarrhea among children under 36 months old
in rural western China. PLoS One. 2012;7(8):e43103.
[4].
World
Health Organization. Universal Health Coverage (UHC). Geneva: WHO; 2020.
[5].
Peters
DH, Garg A, Bloom G, Walker D, Brieger WR, Rahman MH. Poverty and access to
healthcare in developing countries. Ann N Y Acad Sci. 2008;1136:161–171.
[6].
World
Health Organization. Closing the Gap in a Generation: Health Equity Through
Action on the Social Determinants of Health. Geneva: WHO; 2008.
[7].
World
Health Organization Commission on Social Determinants of Health. Closing the
Gap in a Generation. Geneva: WHO; 2008.
[8].
Suchman
EA. Social patterns of illness and medical care. J Health Hum Behav.
1965;6(1):2–16.
[9].
Andersen
RM. Revisiting the behavioral model and access to medical care. J Health Soc
Behav. 1995;36(1):1–10.
[10]. Creswell JW, Creswell JD.
Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 5th
ed. Thousand Oaks (CA): Sage Publications; 2018.
[11]. Adegoke AA. Correlates of
health behaviour practices among literate adults of South-West Nigeria. BMC
Public Health. 2010;10(2).
[12]. Kanungo S, Mahapatra T,
Bhowmik K, et al. Perceived morbidity, health-seeking behaviour and their
determinants in a poor-resource setting in India. PLoS One.
2015;10(5):e0125865.
[13]. Mani G, Annadurai K,
Danasekaran R. Perceptions and health-seeking practices among an urban
population of Tamil Nadu, India: a baseline survey. MRIMS J Health Sci.
2014;2:37–39.
[14]. Manzi A, Munyaneza F,
Mujawase F, et al. Assessing predictors of delayed antenatal care visits in
Rwanda: a secondary analysis of the Rwanda Demographic and Health Survey 2010.
BMC Pregnancy Childbirth. 2014;14(1):290–299.
[15]. Moyer
CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM. It's up to the woman's
people: how social factors influence facility-based delivery in rural Northern
Ghana. Matern Child Health J. 2014;18(1):109–119.
[16]. Mwase I. Social Capital and
Household Health-Seeking Behaviour for Children in the Context of Urban
Neighbourhoods: The Case of Khayelitsha in the Western Cape, South Africa
[dissertation]. Cape Town: University of Cape Town; 2015.
[17]. Nyonator FK, Kutzin J. The
effects of user fees in the Volta Region of Ghana. Health Policy Plan.
1999;14(4):329–341.
[18]. Ibiwoye A, Adeleke IA. Does
national health insurance promote access to quality healthcare? Geneva Pap Risk
Insur Issues Pract. 2008;33(2):219–233.
[19]. Ilesanmi
OS, Adebiyi AO, Fatiregun AA. National Health Insurance Scheme: how protected are
households in Oyo State, Nigeria? Health Policy Plan. 2014;29(2):173–180.
[20]. Carrin G, Mathauer I, Xu K,
Evans DB. Universal coverage of health services: tailoring its implementation.
Bull World Health Organ. 2008;86(11):857–863.
[21]. Ministry of Health Zambia.
National Health Strategic Plan 2022–2026: Towards Attainment of Quality
Universal Health Coverage Through Decentralisation. Lusaka: Ministry of Health;
2023.
[22]. Mkhailef Hawi Al-tameemi M, Bahmanpour K, Mohamadi-Bolbanabad A, Moradi Y, Moradi G. Insights into determinants of health-seeking behavior: a cross-sectional investigation in the Iraqi context. Front Public Health. 2024;12:1367088.
