Determinants of Utilization of Modern Health Facilities in Côte D'ivoire: Evidence from a National Household Survey

Abstract

Background: There are numerous inequalities in access to health care that persist in most countries and that are alarming in sub- Saharan Africa. Access to quality care determines how people use care and how they use modern health services. This article examines  the various patterns of use of healthcare and the factors that determine the use of modern health services in the three residential areas  of Abidjan, the capital city, urban and rural areas.

Methods: We used data from the national household living standards survey conducted in 2015. Extraction from sociodemographic,  economic data, reported morbidity and use of modern, traditional, and mixed care during the 4 weeks preceding the survey have been  made. A one-way analysis helped identify the factors associated with the use of modern care as well as a multi-faceted analysis that served for identifying the determinants of such access. Pearson's Chi2 Test, Odds ratios, and confidence intervals were calculated and the  significance of the tests was set at 0.05.

Findings: Out of a total l of 12,899 households and 47,635 individuals interviewed, 3084, 2083 and 609 have reported illness in rural, urban  and Abidjan respectively. In rural, urban, and economic capital areas, the majority of people used modern health care (53.8%,  58.5%, and 61.6% respectively). Renunciation to care was 31% overall. Demographic, economic and health characteristics were identified  as predicting the use of modern care in the three residential areas. Age was most strongly associated with Abidjan (OR=7.29 for children  under 5 years of age and OR= 4.92 for those of 5 to 14 years old). Single people, compared to married people used less modern care with  ORs of 0.52, 0.59, and 0.60 in both Abidjan and in urban and rural areas. Compared to the richest quintile, the two poorest quintiles had  even less use of modern care in urban (OR=0.43 and 0.53) and rural (OR=0.54 and 0.66) areas. In urban areas and Abidjan, the transfer of  insurance costs to an insurance company or a relative (OR=3.41 and OR=2.71), and the existence of a chronic disease (OR=1.85 and OR=2)  increased the use of modern care. The long distance to a health facility reduced this use in rural areas (OR=0.71).

Conclusion: This work  has highlighted predictors of healthcare use that could serve as a driving force for action against social inequalities of health. It also  shows the need to improve the understanding of the social factors at both collective and individual level that determine care utilization  behaviors as financial barriers and geographical access difficulties are overcome.