Doctoral Degrees (Economics)
Permanent URI for this collection
Browse
Browsing Doctoral Degrees (Economics) by Author "Chari, Abigail"
Now showing 1 - 1 of 1
Results Per Page
Sort Options
- ItemAccess to healthcare services in resource-constrained environments : evidence from Zimbabwe(Stellenbosch : Stellenbosch University, 2023-12) Chari, Abigail; Burger, Ronelle; von Fintel, Dieter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.ENGLISH SUMMARY: Access to healthcare services is fundamental to health and well-being, yet approximately half of the world’s population is unable to access healthcare services in times of need, which derails attainment of the Sustainable Development Goals. Weak access to healthcare services is a global health challenge, and is prevalent in Zimbabwe. This weak access is attributed to a fragile and fragmented health system, characterised by weak and ineffective service delivery. The fragmented health system affects particularly the already disadvantaged population through healthcare services that are either unaffordable or unavailable. As part of achieving the global Sustainable Development Goals, Zimbabwe aims to address inequality in and weak access to its healthcare services. This thesis examined fiscal incidence and inequality in access to healthcare services in Zimbabwe, using 2017 administrative health expenditure data from the Ministry of Health and Child Care and the Prices, Income, Consumption and Expenditure Survey of the Zimbabwe National Statistics Agency. Fiscal incidence was found to be, on average, pro-poor for Zimbabwe’s low-level facilities, and pro-rich for high-level facilities. It was further found that availability and affordability are, on average, pro-rich. Thus, differential access to health services between rural and urban areas was contributing to pro-rich inequality. Despite government healthcare expenditure, inequality in availability and affordability of healthcare services remains a challenge. Pockets of inequality persist in the healthcare sector, as the more affluent continue to benefit from well-resourced facilities. The government should, therefore, focus on poor and rural populations, who bear the brunt of weak access to healthcare services. While the effects and causes of drug stockouts are well articulated, there is a dearth of literature on the link between district-level drug stockouts and poverty. This thesis investigated the spatial inequality of drug stockouts and the relationship between drug stockouts and district poverty in Zimbabwe using data on district-level drug stockouts and poverty. The results showed that spatial inequality in drug stockouts and district poverty exists, while the relationship between drug stockouts and district poverty was weak and insignificant. Spatial interdependence in drug stockouts between districts also exists, indicating hot spots in drug stockouts. In times of drug stockouts, individuals tend to use alternatives to healthcare, some of which pose health dangers, and it is therefore important to improve drug availability in underserved districts by reducing spatial inequality and hot spots in drug stockouts. Given the negative effects of malaria on the vulnerable population, this thesis examined the association between malaria prophylaxis stockouts and birth- and maternal outcomes in Zimbabwe. Preventive efforts against malaria are crucial, given that pregnant women and neonates bear the greatest malaria burden. Therefore, it was hypothesised that women who do not receive malaria prophylaxis during pregnancy are at risk of malaria infections, which compromise birth weight and cause maternal anaemia. Combining the administrative data on malaria prophylaxis stockouts and 2015 nationally representative Demographic Health Survey data, the results showed that malaria prophylaxis stockouts occur frequently over time, and have a significant association with birth weight, especially for neonates with an average birth weight. Stockouts are associated with neonates tending towards the lower end of a normal birth weight, compromising their development. Thus, there is a need to invest in pharmaceutical information- and stock-ordering systems to improve drug availability at the point of care. In conclusion, there is inequality in healthcare services in Zimbabwe, which causes a heavy burden on poor and rural populations. These vulnerable populations have weak access to healthcare services, despite the government's efforts to improve service provision. This thesis sheds more light on access to healthcare services, to enhance relevant stakeholders’ understanding of this subject. To achieve an equitable society, policymakers should address the inequalities in access to healthcare services, together with the socio-demographic determinants of health. Policymakers should improve resource management, follow a needs-based approach, invest in pharmaceutical information systems and stock-ordering systems, and foster multi-stakeholder collaboration to ensure improved access to healthcare services.