May 1 st 2014 Cambodian Team facilitated by Prof. Khang Health Inequality Monitoring Workshop

1. Current Status, Trends, and International Comparison of Health Inequalities in Maternal and Child Health Indicators in Cambodia May 1st2014 Cambodian Team facilitated by Prof. Khang Health Inequality Monitoring Workshop

2. Table of Contents • Background • Objectives • Methods • Results • Discussion • Conclusion

3. I. BACKGROUND • Cambodia has made improvement in maternal and child health which were monitored by using predefined health indicators. • Access to health care for all remains major challenges in Cambodia. • With limited financial health protection, disadvantaged population was less likely to access health services than better off. • However, the health inequality among people from different demographic and socio-economic status was not documented by previous studies.

4. II. OBJECTIVES • To monitor current status and trends of inequality in maternal and child health indicators across various socio-economics factors, educational levels, residential locations, and regions. • To identify the inequality of maternal and child health services delivery between Cambodia and other countries with similar context.

5. III. METHODS

6. Data Source and Health Indicators • Data source: Cambodia Demographic and Health Surveys in 2000, 2005, and 2010. • Health indicators: Family planning needs satisfied (FP), contraceptive prevalence of modern methods (CPM), contraceptive prevalence of modern and traditional methods (CPMT), antenatal care at least one visit (ANC1), antenatal care at least four visits (ANC4), births attended by skilled health personnel (SBA), early initiation of breastfeeding (EIBF), DPT3 immunization (DPT3), careseeking for pneumonia (CSP), and stunting in children under 5 years (Stu5)

7. Inequality Stratifiers • Wealth index Richest, richer, middle, poorer, and poorest • Education None, primary, and secondary/higher • Area Urban and rural • Region All provinces in Cambodia

8. Measures for Health Inequality Analysis • Absolute inequality • Range difference • Between range variances • Slope index of inequality • Relative inequality • Range ratio • Theil index • Relative concentration index • Scaling of action taken • 1: no action • 2: action is needed • 3: action is urgently needed

9. IV-RESULTS

10. Table 1: Time Trend of Health Indicators and Inequality Stratifiers 1: no action; 2: action is needed; 3: action is urgently needed

11. Table 2: Latest Status of Health Indicators and Inequality Stratifiers 1: no action; 2: action is needed; 3: action is urgently needed

12. Figure 1: Inequality of ANC 4 Visits by Wealth Index Absolute inequality of ANC4 visit by wealth index was significantly increased from 2000 to 2010 (Slope index of inequality 24.2 in 2000, 45.2 in 2005, and 46.7 in 2010).

13. Figure 2: Inequality of ANC 4 Visit by Educational Levels

14. Figure 3: ANC 4 Visits by Regions Absolute inequality of ANC4 visit by region measured by between group variance increased from 122.9 in 2005 to 186.6 in 2010

15. Table 3: Results of Benchmarking of Inequality in Health Service Delivery 1: no action; 2: action is needed; 3: action is urgently needed

16. According figure 4 and 5, action is needed for ANC 4 visits, based on comparison with other countries within the same region

17. Summary of Remarkable Results • In general, inequality of maternal and child health indicators based on time trend and latest status analysis was decreased. • Inequality of ANC 4 visits was significantly increased all inequality stratifiers. • Inequality mostly presented by region, particularly contraceptive prevalence (modern methods), antenatal care (at least four visits), and births attended by skilled health personnel. • In comparison with other countries within the region, inequality of maternal and child health was not high that urgently needs to take action.

18. V-DISCUSSIONS

19. Inequality of ANC 4 Visit Inequality of ANC 4 visits was increased in all inequality stratifiers due to lack of financial health protection and low educational level for poor and vulnerable population. Multi-sectoral collaborations and interventions are urgently required.

20. Inequality of Health Services by Region Inequality mostly presented by region across all inequality stratifiers. • Inequality of maternal and child health tended to decrease, but due to low use of health services by few provinces, health inequality remains significantly large. Urgently take action to increase health service utilization in those provinces in terms of promoting service availability, accessibility, and acceptibility.

21. Benchmarking In comparison with other countries within the region, Cambodia seems not need to take any urgent action to minimize the inequality of maternal and child health services. • Inequality of those services remain approximately 40 percent. • Take into account the equity in health policy through promoting health service utilization in line with health inequality monitoring.

22. VI- CONCLUSION • Inequality of ANC 4 visits was increased across all inequality stratifiers. • Inequality of all indicators remain large across provinces due to the low service coverage in few provinces. • Although, Cambodia seems not need to take any urgent action to minimize the inequality in comparison with other countries within region, inequality remain large. • Introducing the equity in health policy and practices through promoting health service utilization in line with health inequality monitoring.