Assignment3: Introduction

Despite of the considerable improvement on the public health conditions over the last decades, issues of health inequality and low coverage of public health services still constantly torment people in developing countries like Kenya. The disparities and inequalities of access to public health care among different regions or population in Kenya can be attributed into three categories: affordability, availability, and geographical accessibility. First, the variations in affordability of health care services are largely dependent on people’s income. In Kenya, people in poverty suffer from both high medicine price and health facility user fees that has to be paid for different services. Second, people’s access to essential public health care is also undermined by the regional variations of availability for different services like drug and vaccination storage, health care workforce density, and life-saving commodities. The third perspective is the various geographical accessibility to closest health facility. Long travel times to health facilities are found to be strongly correlated with delayed uptake of healthcare and increasing mortality, especially for patients with emergent diseases. Essentially, all these disparities on health care among different population place burdens on Kenya’s health system and prevent the continuous improvement of its overall health state. Major health burdens on Kenya’s public health system because of health inequality include relative high under-5 mortality rate of 51.3 per 1000 which decreased at a stagnant rate, high maternal mortality rate of 25.7 deaths per 10 000, and high mortality caused by both communicable and noncommunicable diseases.

Therefore, alleviating health inequality should be considered as one of the most important development goals for Kenya. My central research question is how to improve the people’s equitable access to Kenya’s public health services in order to address the major health disparities and inequalities in Kenya. However, improving health equality is not an easy development process as there underlie many inherent problems which resist the health system to achieve equality. The most prominent one is the trade-offs between geographical equity and health system efficiency, which is hard to be balanced during the policy making process. Allocating health facilities in urban areas with more concentrated population will improve health system’s efficiency while this preferential deployment of will exacerbate urban rural disparities and health inequality. In order to achieve more equitable geographical accessibility for the whole country, some efficiency has to be sacrificed. Despite of the complex nature of public health system, geographical scientific methods can be applied to analyze the situation and then optimize the allocation. For example, a Geo-PSA model was developed to evaluate the trade-offs between geographical equity and health system efficiency, and the impact of far geographical distance can be modeled using mobile-phone data.