Inequitable coverage of non-communicable diseases and injury interventions in India.
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Date
2010-09
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Abstract
Background. We examined the inequities in coverage of
interventions for non-communicable diseases (NCDs) and
injuries in India.
Methods. Data collected by the WHO World Health
Survey in 6 Indian states in 2003 were used to estimate the
coverage of interventions for NCDs and injuries. Coverage was
defined as the proportion of individuals who reported receiving
the intervention among those in need of it. Multiple logistic
regression analysis was used to assess inequities in coverage of
interventions. Composite coverage was calculated for each
state and assessed against expenditure on health.
Results. The composite coverage of interventions for
NCDs and injuries for all states combined was 43.9% (95%
CI 43.0%–44.8%), and was higher in urban than in rural
areas. Lower wealth quintiles had higher odds of being in need
of interventions but lower odds of being covered. Overall, the
highest quintile had composite coverage of 54.5%, compared
with 34.1% for the lowest quintile. The states with lower
coverage of interventions had a higher proportion of households
reporting selling items or borrowing money to cover health
expenditure; this proportion was highest (58.8%) in Rajasthan
state that had the lowest composite coverage (36.6%).
Conclusion. The higher need for and lower coverage of interventions for NCDs and injuries in the poor, and the associated high risk of further adverse economic impact due to health spending, suggest that the public health system of India should improve access to these interventions at no cost for the economically disadvantaged.
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Raban Magdalena Z, Dandona Rakhi, Kumar G Anil, Dandona Lalit. Inequitable coverage of non-communicable diseases and injury interventions in India. National Medical Journal of India. 2010 Sept-Oct; 23(5): 267-273.