Decreasing the Burden of Childhood Disease - Western Cape ...

The problem of inequity
Many of these global interventions are also suggested in the
Recommendations section below and they are also the most important
technical interventions to reduce U-5MR in the Western Cape. Their
current coverage is neither universal nor equitable. For example, analysis
of the 1996 census data (Cape Town Equity Gauge, unpublished) reveals
that the provision of basic services is inequitable across Cape Town, with
a high proportion of households in Khayelitsha and Nyanga living in
informal housing and not having adequate access to water and sanitation.
Inequities in health service financing and delivery have also been
documented for the Metro Region and need to be addressed (Cape Town
Equity Gauge, unpublished).
The problem of inequity is not confined to the Western Cape. Based on
experience in Brazil and elsewhere, Victora et al (2000) has suggested
that new medical technologies provided by the public sector are also
preferentially taken up by higher socio-economic status households. A
study of over 40 countries reports that even those interventions generally
thought to be especially “pro-poor”, such as oral re-hydration therapy and
immunisation, tend to attain better coverage among better-off groups
than among disadvantaged ones (Gwatkin, 2001). The failure of health
services to reach the poor in developing countries, despite their higher
disease burden, is not just a matter of the better-off using their higher
incomes to purchase care from the private sector. Poor people also benefit
less from government subsidies to the health sector.
Victora et al (2003) suggest that the poor face a number of obstacles:
‣ less knowledge;
‣ greater distances to services;
‣ greater out-of-pocket costs because of a lack of insurance; and
‣ more disorganised and poorer quality services with shortages of
drugs and supplies.
They then suggest a number of possible interventions that could
specifically improve the health of poor children, as shown in Table 3
below. They cover a range of options: from education and knowledge to
water and sanitation.