Inequalities in healthcare utilization and benefit incidence analysis (BIA) of publicly financed health facilities in Afghanistan

Objective The objective is to analyze the extent of inequalities in healthcare utilization to determine who is benefiting from publicly financed healthcare services across socio-economic groups and whether distribution appropriately targets the poor.

Methodology The Automated DEC Poverty Tables (ADePT) software was used with data from the Afghanistan Mortality Survey (AMS) 2010 and the National Health Accounts. Since ADePT has no data manipulation capability, STATA was used to clean and manipulate the data before analyzing in ADePT. The following variables were analyzed across a wealth index with public spending costs: inpatient admissions in the last 12 months, outpatient visits in the last month, under five mortality, and antenatal care utilization.

Results The findings show that outpatient BPHS services are the most pro-poor while hospital care for both outpatient and inpatient services tend to favor the wealthy. The share of public expenditures across health facilities is concentrated on hospitals, with 31.5 percent of inpatient spending for National Hospitals, which favor the rich. The majority of National Hospitals are based in Kabul, the largest urban center of the country, which is home to XX percent of the total population. Furthermore, Regional and Provincial Hospitals are located in smaller urban centers, yet receive the bulk of inpatient admissions that tend to favor public spending for the wealthy, though the distributional gap between the poor and rich is less than that of National Hospitals. At the District level and below is when both inpatient and outpatient services begin to shift toward a distribution of public spending that is more pro-poor. Nonetheless, total public expenditures are marginally better for the poor for both inpatient and outpatient services.