title: Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care.
abstract: BACKGROUND
  Health systems aim to narrow inequality in access to health care across socioeconomic groups and area of residency. However, in low-income countries, studies are lacking that systematically monitor and evaluate health programs with regard to their effect on specific inequalities. We aimed to measure changes in inequality in access to maternal and child health (MCH) interventions and the effect of Primary Health Care (PHC) facilities expansion on the inequality in access to care in Ethiopia.
  
  
  METHODS
  The Demographic and Health Survey datasets from Ethiopia (2005 and 2011) were used. We calculated changes in utilization of MCH interventions and child morbidity. Concentration and horizontal inequity indices were estimated. Decomposition analysis was used to calculate the contribution of each determinant to the concentration index.
  
  
  RESULTS
  Between 2005 and 2011, improvements in aggregate coverage have been observed for MCH interventions in Ethiopia. Wealth-related inequality has remained persistently high in all surveys. Socioeconomic factors were the main predictors of differences in maternal and child health services utilization and child health outcome. Utilization of primary care facilities for selected maternal and child health interventions have shown marked pro-poor improvement over the period 2005-2011.
  
  
  CONCLUSIONS
  Our findings suggest that expansion of PHC facilities in Ethiopia might have an important role in narrowing the urban-rural and rich-poor gaps in health service utilization for selected MCH interventions.
authors: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. solomon.memirie@igs.uib.no.
authors: Solomon Tessema
authors: ST
authors: Memirie
authors: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: Stéphane
authors: S
authors: Verguet
authors: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors: Ole F
authors: OF
authors: Norheim
authors: Department of Global Health, University of Washington, Seattle, WA, USA.
authors: Carol
authors: C
authors: Levin
authors: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors: Kjell Arne
authors: KA
authors: Johansson
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D005002:Ethiopia; D005260:Female; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution