Poverty and Disability: A critical review of the literature in low and middle-income countries

While it is widely assumed that disability, poverty and health are closely linked, this is the first critical review on the subject that explicitly asks: ‘What is the current evidence base for the link between poverty, disability and health in low- and middle-income countries? The methods used have been adapted from the EPPI Centre (EPPI-Centre, 2007) and the work of Greenhalgh (Greenhalgh, Robert, Macfarlane, Bate, Kyriakidou, & Peacock, 2005) A total of 964 papers were identified and, of these, 293 were selected for further review based on appropriateness of fit. An initial review of the 293 papers, paying particular attention to those papers that presented an evidence base, found only 27 papers (9.2% of total papers reviewed) met the established inclusion criteria for a critical review. Widening these inclusion criteria did not produce significantly more evidence based papers for review. Thus, the most significant finding from this study is the current lack of strong evidence on the links between disability, poverty and health in LMICs upon which to build global policy and programming. Within the group of papers available for review, we identify a small but growing evidence base that indicates that there are substantial links between disability, poverty and health; however emerging research indicates that these links are more complex and nuanced than is currently assumed. We conclude with a call for more attention to building an evidence base on the interactions between disability, poverty and health. The absence of a robust evidence base that explicitly links these issues, in conjunction with the lack of appropriate benchmarks and indicators to measure disability rights commitments (including poverty reduction), will otherwise result in a “democratic deficit”

An equity analysis of utilization of health services in Afghanistan using a national household survey

Abstract Background Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. Methods We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). Results Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. Conclusions The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector’s role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches in health should be prioritized to promote more inclusive health system reforms