72012 Health Equity and Financial Protection Datasheets L atin America Acknowledgements These datasheets were produced by a task team consisting of Caryn Bredenkamp (Task Team Leader, Health Economist, HDNHE), Adam Wagstaff (Research Manager, DECHD), Leander Buisman (consultant), Leah Prencipe (consultant) and Devon Rohr (consultant, graphic design), under the overall supervision of the Sector Manager, HDNHE, Nicole Klingen. The financial contributions of the Rapid Social Results Trust Fund (RSR-MDTF) and the Trust Fund for Environmentally and Socially Sustainable Development (TFESSD) are gratefully acknowledged. Table of contents Belize.............................................................................................................5 Bolivia........................................................................................................... 6 Brazil............................................................................................................. 8 Colombia..................................................................................................... 11 Dominican Republic..................................................................................13 Ecuador.......................................................................................................16 Guatemala.................................................................................................. 18 Guyana........................................................................................................19 Haiti..............................................................................................................21 Honduras................................................................................................... 23 Mexico........................................................................................................ 25 Nicaragua................................................................................................... 27 Paraguay.................................................................................................... 29 Peru............................................................................................................. 32 Suriname.................................................................................................... 34 Uruguay...................................................................................................... 35 Interpretation of Results Measurement of Indicators HealtH equity and Financial Protection dataSHeet Belize the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 2006 2 outcoMeS Stunting 38.4% 23.8% 17.2% 16.5% 7.9% 22.9% -0.287*** underweight 10.2% 5.5% 5.0% 2.0% 0.7% 5.3% -0.394*** diarrhea 15.7% 12.2% 12.5% 9.2% 8.1% 12.0% -0.124** acute respiratory infection 19.5% 16.5% 10.4% 13.9% 12.9% 15.0% -0.099** inequalitieS in riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci riSky BeHavior 2006 2 concurrent partnerships 1.4% 1.4% 3.4% 1.6% 0.0% 1.6% -0.168 inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interventionS1,2 utiliZation 2006 2 contraceptive prevalence 19.1% 31.2% 37.3% 36.6% 37.7% 33.1% 0.098*** adult Preventive care2,3 q1 q2 q3 q4 q5 total ci 2006 2 voluntary counseling and 85.6% 87.0% 91.7% 92.9% 96.5% 91.6% 0.026*** testing for Hiv note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1=n/a demographic and Health Survey, 2=2006 Belize Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Belize. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Jonathan French 5 HealtH equity and Financial Protection dataSHeet bolivia the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1998 1b outcoMeS infant mortality rate 114.6 88.9 78.7 38.4 27.7 77.7 -0.238*** under-five mortality rate 165.3 118.1 117.2 45.3 37.2 108.0 -0.253*** Stunting 49.6% 40.1% 30.5% 20.2% 10.4% 33.5% -0.229*** underweight 11.2% 6.3% 4.3% 2.5% 3.1% 6.1% -0.318*** diarrhea 22.0% 20.3% 20.7% 17.6% 11.7% 19.3% -0.080*** acute respiratory infection 26.9% 27 .2% 20.2% 25.1% 21.3% 24.5% -0.038*** Fever 30.5% 28.6% 30.9% 30.6% 25.8% 29.6% -0.015 2003 1c infant mortality rate 92.5 87.3 65.6 53.7 32.6 71.6 -0.162*** under-five mortality rate 133.5 139.3 103.7 74.5 43.8 107 .6 -0.166*** Stunting 48.7% 41.5% 28.1% 18.8% 9.9% 32.5% -0.240*** underweight 9.9% 7.9% 3.7% 2.2% 1.8% 5.7% -0.335*** diarrhea 25.0% 23.4% 22.4% 23.4% 15.2% 22.6% -0.063*** acute respiratory infection 21.9% 21.0% 23.2% 26.6% 21.9% 22.9% 0.023* Fever 34.1% 33.6% 30.2% 31.7% 29.0% 32.1% -0.031*** 2008 1d infant mortality rate 94.4 66.8 47.7 35.4 26.7 59.4 -0.239*** under-five mortality rate 120.6 93.0 74.8 52.6 32.1 82.0 -0.219*** Stunting 45.1% 34.4% 21.9% 15.1% 6.6% 27 .1% -0.292*** underweight 8.1% 5.1% 3.2% 2.2% 2.2% 4.5% -0.305*** diarrhea 30.5% 27 .1% 28.1% 21.8% 19.5% 26.2% -0.076*** acute respiratory infection 24.1% 20.1% 20.2% 17.0% 17.1% 20.1% -0.064*** adult HealtH1a,1b,1c,1d,3 q1 q2 q3 q4 q5 total ci 1994 1a obesity among non-pregnant 1.0% 5.7% 12.1% 14.1% 8.4% 8.0% 0.279*** women 1998 1b obesity among non-pregnant 4.7% 9.9% 13.8% 14.9% 15.1% 11.4% 0.197*** women 2003 1c obesity among non-pregnant 5.8% 12.6% 16.5% 19.4% 17.5% 15.3% 0.137*** women 2008 1d obesity among non-pregnant 8.2% 15.8% 20.1% 23.2% 16.8% 17.4% 0.084*** women 6 inequalitieS in riSk FactorS1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2003 1c concurrent partnerships 4.4% 5.3% 6.9% 9.6% 14.8% 8.8% 0.251*** condom usage (more than 2.1% 9.7% 10.5% 22.1% 25.3% 18.8% 0.219*** one partner) 2008 1d Smoking (women) 6.2% 5.4% 6.7% 8.1% 14.8% 8.6% 0.226*** inequalitieS Maternal and cHild HealtH q1 q2 q3 q4 q5 total ci in HealtH care interVentionS1a,1b,1c,1d,2 utiliZation 1998 1b Full immunization 22.1% 24.9% 20.9% 33.9% 30.5% 25.6% 0.075** treatment of diarrhea 45.1% 47.2% 49.2% 50.5% 58.0% 48.4% 0.042** Medical treatment of ari 27.4% 37.4% 41.3% 58.9% 69.4% 42.5% 0.187*** Skilled antenatal care (4+ visits) 17.8% 35.8% 52.2% 72.4% 86.3% 47.2% 0.295*** Skilled birth attendance 19.0% 44.5% 68.9% 88.5% 98.4% 57.5% 0.295*** 2003 1c Full immunization 47.8% 49.8% 44.4% 59.3% 58.1% 50.9% 0.037** treatment of diarrhea 37.9% 37.0% 38.9% 38.6% 40.1% 38.2% 0.007 Medical treatment of ari 39.5% 54.2% 49.4% 46.8% 57.4% 48.3% 0.049*** Skilled antenatal care (4+ visits) 30.7% 48.2% 59.4% 72.1% 89.2% 57.5% 0.197*** Skilled birth attendance 25.1% 49.6% 71.2% 88.0% 98.6% 61.1% 0.249*** contraceptive prevalence 59.9% 58.0% 55.1% 56.6% 54.7% 56.3% -0.010 2008 1d Full immunization 67.9% 68.0% 67.0% 68.4% 63.5% 67.2% -0.008 treatment of diarrhea 38.5% 45.7% 47.0% 48.4% 40.6% 43.8% 0.033* Medical treatment of ari 40.6% 49.2% 53.8% 55.0% 69.9% 50.9% 0.098*** Skilled antenatal care (4+ visits) 44.3% 63.3% 75.8% 84.0% 91.6% 70.3% 0.136*** Skilled birth attendance 36.0% 64.6% 81.5% 92.2% 98.7% 70.8% 0.188*** contraceptive prevalence 55.7% 51.5% 48.7% 50.3% 49.9% 50.5% -0.010 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1a=1994 Bolivia demographic and Health Survey, 1b=1998 Bolivia demographic and Health Survey, 1c=2003 Bolivia demographic and Health Survey, 1d=2008 Bolivia demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Bolivia. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. 7 HealtH equity and Financial Protection dataSHeet Bra zil the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1996 1 outcoMeS infant mortality rate 85.9 50.1 36.1 24.1 28.0 50.1 -0.261*** under-five mortality rate 106.4 61.1 44.4 32.8 47.6 63.5 -0.220*** Stunting 27 .0% 11.6% 7.4% 4.1% 3.6% 13.0% -0.415*** underweight 9.5% 3.9% 2.3% 1.8% 1.7% 4.6% -0.414*** diarrhea 14.1% 9.2% 9.5% 8.1% 5.7% 10.0% -0.153*** acute respiratory infection 26.3% 27 .1% 23.4% 21.4% 20.9% 24.4% -0.049*** Fever 30.5% 26.9% 25.4% 21.8% 21.9% 26.1% -0.072*** 2003 3 diarrhea 35.4% 38.2% 26.2% 40.7% 13.7% 32.6% -0.094* acute respiratory infection 37.0% 25.8% 26.8% 24.6% 33.4% 29.7% -0.056 Fever 72.8% 77.1% 77.6% 71.4% 60.7% 73.3% -0.025 adult HealtH1,3 q1 q2 q3 q4 q5 total ci 1996 1 obesity among non-pregnant 6.3% 9.9% 12.0% 12.1% 9.5% 9.8% 0.097*** women 2003 3 tuberculosis 20.6% 18.4% 15.0% 11.4% 11.8% 15.4% -0.131*** obesity among non-pregnant 9.2% 8.8% 9.2% 8.9% 7.5% 8.7% -0.028 women road traffic accident 2.4% 3.2% 3.9% 3.1% 2.5% 3.0% -0.001 non-road traffic accident 9.6% 8.3% 6.4% 7.6% 7.4% 7.8% -0.068** angina 6.7% 7.2% 8.5% 6.4% 5.3% 6.8% -0.058* arthritis 11.9% 10.3% 10.0% 11.4% 9.7% 10.7% -0.024 asthma 10.8% 12.4% 10.4% 12.8% 14.3% 12.2% 0.056** depression 17.2% 18.0% 19.9% 20.9% 23.3% 19.8% 0.063*** diabetes 5.4% 5.7% 7.4% 7.2% 6.2% 6.4% 0.051 difficulty with work and 15.4% 12.5% 10.6% 8.0% 5.7% 10.4% -0.187*** household activities Poor self-assessed health 14.2% 12.6% 9.5% 6.6% 2.9% 9.1% -0.262*** status inequalitieS in riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2003 3 Smoking (all) 30.4% 25.6% 19.8% 17.8% 17.6% 22.2% -0.127*** Smoking (women) 27.4% 21.6% 14.2% 16.8% 16.7% 19.5% -0.110*** insufficient intake of fruit and 69.4% 62.3% 59.0% 56.4% 51.5% 57.6% -0.054*** vegetables insufficient physical activity 24.5% 23.1% 23.9% 20.6% 24.5% 23.3% -0.010 drinking 7.5% 10.6% 11.7% 11.9% 13.3% 11.0% 0.092*** 8 inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1,2 utiliZation 1996 1 Full immunization 57.3% 73.9% 85.9% 83.1% 75.6% 73.1% 0.076*** treatment of diarrhea 42.6% 47.9% 51.6% 37.3% 29.3% 43.6% -0.010 Medical treatment of ari 33.0% 48.3% 48.2% 52.8% 64.7% 46.2% 0.124*** Skilled antenatal care (4+ visits) 53.4% 79.5% 90.0% 95.2% 97.2% 78.9% 0.130*** Skilled birth attendance 72.8% 89.5% 96.8% 97.9% 99.3% 88.8% 0.071*** adult PreVentiVe care2,3 q1 q2 q3 q4 q5 total ci 2003 3 tB screening 6.5% 6.5% 6.8% 8.4% 9.3% 7.5% 0.096*** cervical cancer screening 85.3% 86.3% 86.1% 87 .0% 90.0% 87 .1% 0.009* Breast cancer screening 23.5% 23.9% 50.3% 59.5% 75.0% 48.3% 0.243*** adult curatiVe care3 q1 q2 q3 q4 q5 total ci 2003 3 inpatient or outpatient 53.7% 55.6% 61.4% 61.9% 65.1% 59.5% 0.042*** (12 months) inpatient (12 months) 14.1% 11.1% 10.5% 11.8% 8.8% 11.3% -0.067*** inpatient (5 years) 34.7% 31.6% 27.7% 31.1% 27.7% 30.6% -0.039*** outpatient (12 months) 61.3% 65.1% 70.9% 72.9% 78.7% 70.0% 0.051*** threshold share of total household consumption Financial cataStroPHic out-oF- 5% 10% 15% 25% 40% Protection Pocket SPending3 2003 3 Headcount 50.1% 36.2% 26.8% 15.0% 6.6% concentration index 0.129*** 0.138*** 0.164*** 0.209*** 0.284*** threshold share of nonfood consumption cataStroPHic out-oF- 5% 10% 15% 25% 40% Pocket SPending3 2003 3 Headcount 59.9% 51.8% 44.8% 32.5% 20.6% concentration index 0.088*** 0.071*** 0.054*** 0.022 0.005 iMPoVeriSHMent3 Poverty line at uS$1.25 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Percentage in poverty 14.0% 16.1% 2.0 pp 14.6% average shortfall from the $0.06 $0.08 $0.01 16.9% poverty line average shortfall from the $0.45 $0.46 $0.01 2.1% poverty line, among the poor Poverty line at uS$2.00 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Percentage in poverty 27.9% 31.9% 4.0 pp 14.3% average shortfall from the $0.23 $0.26 $0.03 15.4% poverty line average shortfall from the $0.79 $0.80 $0.01 0.9% poverty line, among the poor 9 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. Poverty lines are at 2005 purchasing power parity, adjusted to current prices using Brazil’s consumer price index. data sources: 1=1996 Brazil demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=2003 Brazil World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Brazil. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit:thomas Sennett 10 HealtH equity and Financial Protection dataSHeet colom bia the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1995 1a outcoMeS infant mortality rate 45.4 33.0 27.2 33.6 15.5 32.9 -0.132*** under-five mortality rate 55.2 44.0 27.0 44.2 17.7 39.8 -0.140*** Stunting 30.0% 22.4% 17 .3% 10.5% 10.5% 19.8% -0.222*** underweight 11.2% 7.2% 4.9% 2.1% 2.6% 6.3% -0.313*** diarrhea 18.8% 19.9% 17 .1% 15.2% 10.3% 16.9% -0.090*** acute respiratory infection 28.1% 22.7% 22.2% 24.1% 27 .0% 24.8% -0.017 Fever 28.1% 28.5% 28.6% 29.8% 26.3% 28.4% -0.001 2000 1b infant mortality rate 33.7 33.3 23.5 13.7 17.9 25.9 -0.141*** under-five mortality rate 46.3 40.4 25.6 11.5 21.2 31.0 -0.195*** Stunting 28.0% 22.5% 16.0% 10.4% 9.7% 18.6% -0.210*** underweight 6.7% 6.4% 4.8% 3.8% 2.8% 5.2% -0.168*** diarrhea 17.8% 16.2% 13.1% 10.4% 10.3% 14.1% -0.107*** Fever 24.2% 26.5% 25.2% 26.9% 26.9% 25.8% 0.038** 2005 1c infant mortality rate 33.1 23.1 21.3 14.3 16.1 22.8 -0.158*** under-five mortality rate 45.9 28.2 25.2 17.8 20.1 28.8 -0.186*** Stunting 24.9% 16.5% 12.9% 9.6% 4.9% 15.6% -0.252*** underweight 7.8% 4.9% 3.3% 4.2% 3.0% 5.0% -0.199*** diarrhea 17 .7% 17.0% 12.9% 11.2% 8.8% 14.4% -0.123*** Fever 27 .6% 25.8% 22.5% 24.4% 21.8% 24.8% -0.042*** 2010 1d infant mortality rate 22.4 19.6 18.5 17.9 12.8 18.9 -0.090*** under-five mortality rate 32.5 25.5 23.8 23.5 13.0 25.0 -0.140*** Stunting 19.3% 12.8% 11.1% 9.3% 6.8% 12.8% -0.187*** underweight 5.7% 3.6% 2.4% 2.0% 1.7% 3.4% -0.266*** diarrhea 16.4% 14.5% 11.4% 10.7% 7.3% 12.7% -0.138*** acute respiratory infection 6.9% 7.3% 7.0% 5.0% 3.9% 6.3% -0.094*** Fever 26.4% 26.5% 25.3% 25.6% 21.2% 25.4% -0.029*** adult HealtH1a,1b,1c,1d,3 q1 q2 q3 q4 q5 total ci 1995 1a obesity among non-pregnant 7.0% 12.1% 8.5% 8.2% 11.6% 9.3% 0.045 women 2000 1b obesity among non-pregnant 7.7% 8.8% 12.4% 11.8% 13.3% 10.7% 0.142*** women 2005 1c obesity among non-pregnant 9.7% 11.5% 12.3% 12.8% 11.2% 11.6% 0.027** women 2010 1d obesity among non-pregnant 14.0% 16.0% 14.7% 13.9% 11.9% 14.2% -0.038*** women 11 inequalitieS in riSk FactorS1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci riSky BeHavior 2010 1d concurrent partnerships 15.2% 22.6% 26.5% 27.8% 29.9% 24.8% 0.108*** condom usage (more than 29.9% 34.1% 34.4% 35.9% 40.6% 35.7% 0.049*** one partner) inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interventionS1,2 utiliZation 1995 1a Full immunization 54.1% 66.8% 68.5% 71.2% 74.6% 65.8% 0.065*** treatment of diarrhea 34.4% 48.8% 46.8% 49.6% 49.9% 44.5% 0.078*** Medical treatment of ari 34.9% 49.3% 50.6% 53.4% 67.7% 48.7% 0.129*** Skilled antenatal care (4+ visits) 43.7% 65.8% 80.9% 89.7% 92.2% 70.9% 0.152*** Skilled birth attendance 59.7% 85.5% 91.5% 98.6% 98.3% 84.1% 0.101*** 2000 1b Full immunization 10.6% 16.5% 19.0% 16.9% 10.5% 14.5% 0.057 treatment of diarrhea 32.8% 34.6% 31.3% 29.4% 28.1% 32.1% -0.024 Skilled antenatal care (4+ visits) 60.2% 77.5% 87.2% 92.2% 91.0% 80.6% 0.085*** Skilled birth attendance 63.9% 85.0% 95.1% 98.7% 98.6% 86.3% 0.088*** 2005 1c Full immunization 49.2% 57.4% 66.0% 65.1% 73.7% 59.8% 0.075*** treatment of diarrhea 50.0% 59.1% 56.4% 64.4% 48.6% 55.5% 0.035** Skilled antenatal care (4+ visits) 68.7% 83.2% 89.0% 91.3% 96.0% 84.3% 0.066*** Skilled birth attendance 72.8% 93.6% 97.2% 98.9% 99.2% 90.5% 0.065*** 2010 1d Full immunization 65.2% 67.9% 72.6% 69.7% 66.9% 68.4% 0.015 treatment of diarrhea 57.9% 63.8% 64.7% 57.5% 62.3% 61.0% 0.009 Medical treatment of ari 52.8% 67.8% 68.3% 76.5% 64.1% 64.7% 0.059*** Skilled antenatal care (4+ visits) 78.9% 89.4% 92.5% 95.1% 97.3% 89.8% 0.041*** Skilled birth attendance 83.7% 96.6% 98.7% 99.3% 99.4% 94.6% 0.037*** contraceptive prevalence 68.5% 68.6% 67.4% 67.6% 67.2% 67.8% -0.003 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1a=1995 colombia demographic and Health Survey, 1b=2000 colombia demographic and Health Survey, 1c=2005 colombia demographic and Health Survey, 1d=2010 colombia demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - colombia. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Scott Wallace 12 HealtH equity and Financial Protection dataSHeet dominican repu blic the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1996 1a outcoMeS Stunting 26.8% 12.7% 10.4% 7.5% 3.7% 13.7% -0.344*** underweight 10.3% 4.8% 3.2% 1.5% 1.2% 4.8% -0.426*** diarrhea 10.8% 9.3% 13.1% 9.9% 8.6% 10.5% -0.025 acute respiratory infection 11.7% 10.2% 13.1% 11.1% 9.1% 11.2% -0.027 Fever 30.9% 32.2% 29.6% 32.2% 22.1% 29.8% -0.038** 1999 1b diarrhea 19.1% 21.4% 15.7% 15.2% 9.2% 16.6% -0.107* acute respiratory infection 23.5% 33.1% 30.2% 23.1% 23.7% 27.2% -0.034 Fever 26.6% 31.4% 24.4% 26.9% 12.1% 25.1% -0.068 2002 1c infant mortality rate 54.0 37.6 34.6 26.7 19.4 35.8 -0.164*** under-five mortality rate 74.2 50.3 42.9 32.5 15.2 45.1 -0.229*** Stunting 20.0% 13.3% 10.4% 7.8% 4.2% 11.9% -0.254*** underweight 9.0% 4.1% 3.2% 2.7% 1.4% 4.4% -0.317*** diarrhea 18.0% 16.4% 14.8% 10.7% 8.8% 14.2% -0.136*** acute respiratory infection 23.8% 22.1% 21.6% 18.8% 14.5% 20.6% -0.075*** Fever 30.9% 28.1% 27.4% 27 .2% 19.7% 27.1% -0.066*** 2007 1d infant mortality rate 46.0 35.2 28.8 22.5 24.5 32.6 -0.135*** under-five mortality rate 56.9 41.5 33.2 24.8 22.4 37.3 -0.171*** Stunting 16.9% 10.0% 7.2% 8.0% 5.3% 10.1% -0.227*** underweight 5.6% 4.0% 2.7% 2.5% 0.5% 3.4% -0.266*** diarrhea 16.8% 15.6% 14.5% 13.2% 13.4% 14.9% -0.050** acute respiratory infection 14.8% 13.2% 12.6% 11.5% 7.7% 12.4% -0.091*** Fever 22.7% 22.0% 20.4% 20.9% 19.4% 21.3% -0.034** adult HealtH1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci 1996 1a obesity among non-pregnant 0.075 0.130 0.137 0.139 0.147 0.129 0.086*** women 2003 3 tuberculosis 10.4% 9.0% 7.8% 7.6% 12.2% 9.4% 0.030 road traffic accident 2.4% 4.9% 2.1% 3.3% 2.7% 3.1% -0.009 non-road traffic accident 4.5% 3.8% 5.0% 5.0% 4.1% 4.5% 0.012 angina 3.2% 5.7% 5.4% 3.7% 2.3% 4.0% -0.081 arthritis 12.0% 11.4% 11.2% 12.6% 15.1% 12.5% 0.062 asthma 7.9% 9.7% 11.6% 9.2% 11.6% 10.1% 0.057 depression 4.7% 9.2% 9.8% 11.0% 10.9% 9.4% 0.124*** diabetes 2.8% 2.1% 5.6% 7.2% 4.0% 4.5% 0.132*** difficulty with work and 6.1% 5.0% 6.7% 9.2% 7.4% 6.9% 0.101 household activities Poor self-assessed health 11.6% 9.7% 8.4% 7.6% 6.3% 8.5% -0.114** status 2007 1d HiV positive 1.7% 1.0% 0.6% 0.1% 0.4% 0.8% -0.361*** 13 riSk FactorS1a,1b,1c,1d,2,3 q1 q2 q3 q4 q5 total ci inequalitieS in 2002 1c riSky BeHaVior Smoking (women) 13.3% 11.0% 8.2% 6.9% 5.6% 8.6% -0.176*** concurrent partnerships 10.1% 12.9% 13.2% 14.6% 13.4% 13.0% 0.039*** condom usage (more than 14.5% 19.9% 23.4% 25.2% 25.4% 22.6% 0.081*** one partner) 2003 3 Smoking (all) 26.4% 18.0% 14.8% 10.4% 9.4% 15.1% -0.219*** insufficient intake of fruit and 77.8% 80.3% 76.0% 71.6% 73.5% 75.6% -0.020** vegetables insufficient physical activity 15.4% 15.9% 16.0% 18.0% 19.8% 17.0% 0.058** drinking 8.7% 8.8% 9.4% 10.1% 11.1% 9.7% 0.056 2007 1d Smoking (women) 10.8% 8.4% 6.0% 4.6% 4.8% 6.7% -0.183*** concurrent partnerships 13.4% 16.9% 16.3% 18.3% 16.4% 16.4% 0.035*** condom usage (more than 27.6% 32.6% 33.5% 38.8% 38.9% 35.0% 0.053*** one partner) inequalitieS Maternal and cHild HealtH q1 q2 q3 q4 q5 total ci in HealtH care interVentionS1a,1b,1c,1d,2,3 utiliZation 1996 1a Full immunization 28.0% 30.8% 47.4% 42.2% 51.6% 38.9% 0.142*** Medical treatment of ari 43.9% 46.4% 56.7% 49.0% 60.2% 50.4% 0.058** Skilled antenatal care (4+ visits) 78.7% 86.8% 91.2% 94.7% 97.3% 88.6% 0.045*** Skilled birth attendance 88.2% 96.5% 96.9% 98.2% 97.7% 95.0% 0.022*** 1999 1b Skilled antenatal care (4+ visits) 86.4% 93.0% 94.7% 93.4% 100.0% 93.5% 0.022** Skilled birth attendance 95.6% 99.7% 100.0% 98.2% 93.7% 97.8% -0.002 2002 1c Full immunization 26.9% 33.0% 41.2% 42.9% 36.6% 35.7% 0.082*** treatment of diarrhea 42.7% 30.4% 29.7% 34.8% 17.5% 33.0% -0.102*** Medical treatment of ari 67.7% 61.2% 70.0% 66.3% 51.2% 64.6% -0.020 Skilled antenatal care (4+ visits) 89.5% 94.1% 96.8% 96.4% 98.9% 95.0% 0.019*** Skilled birth attendance 94.2% 99.2% 99.3% 99.6% 99.8% 98.3% 0.012*** contraceptive prevalence 70.3% 71.2% 72.3% 69.0% 70.3% 70.6% -0.002 2007 1d Full immunization 45.1% 52.3% 56.3% 55.9% 71.5% 54.6% 0.088*** treatment of diarrhea 50.1% 46.1% 47.1% 47.7% 39.9% 46.9% -0.022 Medical treatment of ari 61.3% 64.8% 62.2% 61.8% 59.0% 62.3% -0.010 Skilled antenatal care (4+ visits) 82.8% 89.9% 92.7% 95.3% 97.6% 91.1% 0.033*** Skilled birth attendance 88.6% 95.0% 96.2% 97.9% 98.7% 94.6% 0.022*** contraceptive prevalence 73.1% 72.8% 71.4% 68.6% 67.0% 70.5% -0.017*** adult PreVentiVe care2,3 q1 q2 q3 q4 q5 total ci 2003 3 tB screening 3.5% 5.6% 6.7% 7.0% 6.7% 6.0% 0.108* Voluntary counseling and 86.5% 93.8% 94.5% 88.6% 96.2% 92.3% 0.007 testing for HiV cervical cancer screening 68.9% 81.4% 80.5% 79.7% 83.4% 80.0% 0.016 Breast cancer screening 11.2% 9.9% 14.2% 20.3% 29.7% 18.3% 0.220*** adult curatiVe care3 q1 q2 q3 q4 q5 total ci 2003 3 inpatient or outpatient 52.9% 55.4% 56.3% 60.8% 60.3% 57.5% 0.033*** (12 months) inpatient (12 months) 14.1% 11.3% 10.6% 11.4% 9.2% 11.1% -0.069** inpatient (5 years) 31.4% 37.4% 33.7% 34.4% 33.6% 34.2% -0.005 outpatient (12 months) 41.1% 46.4% 46.9% 53.6% 52.2% 48.5% 0.056*** 14 threshold share of total household consumption Financial cataStroPHic out-oF- 5% 10% 15% 25% 40% Protection Pocket SPending 2003 3 Headcount 44.0% 32.0% 23.9% 14.5% 8.0% concentration index 0.076*** 0.062*** 0.060*** 0.069** 0.084* threshold share of nonfood consumption cataStroPHic out-oF- 5% 10% 15% 25% 40% Pocket SPending 2003 3 Headcount 56.9% 51.7% 46.7% 39.4% 30.0% concentration index 0.011* -0.021 -0.049*** -0.082*** -0.145*** iMPoVeriSHMent Poverty line at uS$1.25 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Poverty headcount 14.0% 17.6% 3.6 pp 26.1% average shortfall from the $0.07 $0.09 $0.02 24.9% poverty line average shortfall from the $0.48 $0.47 $0.00 -0.9% poverty line, among the poor Poverty line at uS$2.00 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Poverty headcount 30.5% 35.1% 4.7 pp 15.3% average shortfall from the $0.24 $0.29 $0.05 20.7% poverty line average shortfall from the $0.77 $0.80 $0.04 4.7% poverty line, among the poor note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. Poverty lines are at 2005 purchasing power parity, adjusted to current prices using dominican republic’s consumer price index. data sources: 1a=1996 dominican republic demographic and Health Survey, 1b=1999 dominican republic demographic and Health Survey, 1c=2002 dominican republic demographic and Health Survey, 1d=2007 dominican republic demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=2003 dominican republic World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - dominican republic. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Jonathan French 15 HealtH equity and Financial Protection dataSHeet ECUador the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS adult HealtH1,3 q1 q2 q3 q4 q5 total ci in HealtH 2003 3 outcoMeS tuberculosis 3.6% 8.9% 6.8% 4.4% 6.1% 6.4% -0.082* road traffic accident 0.3% 0.9% 2.5% 0.6% 1.0% 1.2% -0.105 non-road traffic accident 3.8% 4.8% 4.2% 3.5% 3.7% 4.0% -0.044 angina 5.9% 6.0% 3.1% 3.8% 4.5% 4.4% -0.031 arthritis 7.9% 10.8% 8.5% 6.6% 9.0% 8.6% -0.043 asthma 0.0% 2.2% 2.5% 2.1% 4.2% 2.7% 0.161* depression 1.9% 6.4% 8.9% 7.8% 6.0% 7.1% 0.009 diabetes 0.5% 1.7% 2.7% 1.5% 2.3% 2.0% 0.026 difficulty with work and 0.8% 6.1% 6.6% 5.5% 4.6% 4.7% 0.115*** household activities Poor self-assessed health 6.4% 10.6% 11.4% 7.1% 6.0% 8.6% -0.131*** status riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci inequalitieS in 2003 3 riSky BeHaVior Smoking (all) 13.8% 15.6% 15.1% 17.3% 17.8% 16.4% 0.038*** Smoking (women) 0.4% 4.5% 3.3% 9.3% 11.5% 6.8% 0.291 insufficient intake of fruit and 92.2% 88.9% 87.4% 86.0% 86.8% 87.3% -0.006 vegetables insufficient physical activity 0.5% 3.8% 8.3% 6.1% 4.2% 4.6% 0.190*** drinking 30.4% 29.5% 29.9% 36.9% 35.3% 33.0% 0.046* concurrent partnerships 10.4% 2.6% 8.2% 3.9% 5.3% 5.3% -0.005 inequalitieS adult PreVentiVe care2,3 q1 q2 q3 q4 q5 total ci in HealtH care 2003 3 utiliZation tB screening 0.3% 2.0% 1.8% 2.6% 2.6% 2.2% 0.144* Breast cancer screening 28.6% 10.5% 11.4% 14.3% 18.8% 14.6% 0.114 adult curatiVe care3 q1 q2 q3 q4 q5 total ci 2003 3 inpatient or outpatient 36.1% 48.8% 55.1% 49.3% 58.1% 52.3% 0.036** (12 months) inpatient (12 months) 3.6% 7.7% 10.8% 5.1% 4.0% 6.7% -0.138*** inpatient (5 years) 13.8% 20.8% 22.7% 16.7% 15.4% 18.6% -0.060** outpatient (12 months) 20.8% 39.8% 46.2% 41.4% 48.4% 43.2% 0.043** 16 threshold share of total household consumption Financial cataStroPHic out-oF- 5% 10% 15% 25% 40% Protection Pocket SPending 2003 3 Headcount 57 .9% 49.1% 40.7% 31.9% 26.4% concentration index 0.113*** 0.103*** 0.107*** 0.132*** 0.096 threshold share of nonfood consumption cataStroPHic out-oF- 5% 10% 15% 25% 40% Pocket SPending 2003 3 Headcount 64.0% 61.7% 57.9% 50.1% 40.9% concentration index 0.079*** 0.073*** 0.059*** 0.033* 0.002 iMPoVeriSHMent Poverty line at uS$1.25 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Percentage in poverty 6.0% 7.6% 1.6 pp 25.9% average shortfall from the $0.04 $0.05 $0.01 20.1% poverty line average shortfall from the $0.51 $0.49 -$0.02 -4.6% poverty line, among the poor Poverty line at uS$2.00 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Percentage in poverty 14.3% 16.8% 2.4 pp 16.8% average shortfall from the $0.13 $0.16 $0.03 19.7% poverty line average shortfall from the $0.73 $0.75 $0.02 2.5% poverty line, among the poor note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. Poverty lines are at 2005 purchasing power parity, adjusted to current prices using ecuador’s consumer price index. data sources: 1=n/a demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=2003 ecuador World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - ecuador. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Jonathan French 17 HealtH equity and Financial Protection dataSHeet guatemal a the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1995 1 outcoMeS infant mortality rate 61.0 84.4 58.8 49.4 34.1 60.5 -0.087*** under-five mortality rate 99.3 111.3 87.9 70.5 25.3 85.5 -0.147*** Stunting 70.2% 66.7% 59.2% 38.9% 15.0% 55.2% -0.174*** underweight 30.1% 29.0% 21.5% 11.2% 5.3% 21.8% -0.226*** diarrhea 22.9% 21.6% 23.6% 17.6% 16.3% 21.0% -0.054*** acute respiratory infection 23.3% 21.7% 22.2% 23.7% 18.6% 22.2% -0.012 Fever 31.8% 30.4% 27.0% 29.2% 20.4% 28.6% -0.054*** adult HealtH1,3 q1 q2 q3 q4 q5 total ci 1995 1 obesity among non-pregnant 2.3% 4.0% 6.7% 14.2% 17.2% 8.2% 0.395*** women inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interventionS1,2 utiliZation 1995 1 Full immunization 41.5% 43.6% 46.4% 38.6% 43.2% 42.8% 0.006 treatment of diarrhea 54.7% 43.2% 56.8% 55.4% 44.8% 51.6% -0.000 Medical treatment of ari 27.6% 29.8% 47.6% 46.9% 74.0% 40.5% 0.192*** Skilled antenatal care (4+ visits) 22.7% 27.9% 39.1% 62.8% 85.6% 41.9% 0.281*** Skilled birth attendance 9.4% 16.4% 32.8% 63.6% 91.9% 35.4% 0.438*** note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1=1995 Guatemala demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Guatemala. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: curt carnemark 18 HealtH equity and Financial Protection dataSHeet Gu yana the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 2006-07 2 outcoMeS Stunting 27.3% 15.8% 12.2% 12.6% 13.8% 18.0% -0.202*** underweight 10.8% 14.8% 9.5% 10.8% 6.8% 11.0% -0.070* diarrhea 12.4% 9.1% 8.8% 5.5% 5.1% 9.0% -0.202*** acute respiratory infection 12.7% 11.4% 8.3% 12.0% 9.2% 11.0% -0.081** 2009 1 infant mortality rate 26.4 34.4 34.8 44.3 47.4 35.7 0.110* under-five mortality rate 28.9 37.5 27.7 62.5 38.0 37.5 0.115* Stunting 31.8% 19.2% 13.3% 16.3% 14.7% 20.7% -0.206*** underweight 17.8% 15.6% 8.0% 8.3% 3.5% 11.8% -0.245*** diarrhea 16.0% 10.2% 8.7% 5.0% 5.0% 10.0% -0.252*** acute respiratory infection 10.7% 9.2% 9.3% 7.9% 7.5% 9.2% -0.083* Fever 20.2% 21.1% 25.4% 20.9% 13.6% 20.5% -0.032 adult HealtH1,3 q1 q2 q3 q4 q5 total ci 2009 1 obesity among non-pregnant 17.9% 22.7% 21.3% 23.5% 23.2% 22.0% 0.042** women inequalitieS in riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2009 1 Smoking (women) 3.6% 4.4% 2.3% 2.5% 3.6% 3.3% -0.046 concurrent partnerships 12.6% 16.1% 15.8% 15.6% 24.2% 17.2% 0.109*** condom usage (more than 47.6% 51.1% 46.2% 48.6% 57.7% 51.4% 0.026 one partner) Mosquito net use by children 26.8% 28.5% 29.7% 20.5% 14.8% 24.9% -0.087*** inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1,2 utiliZation 2006-07 2 contraceptive prevalence 0.9% 0.1% 0.0% 0.2% 0.1% 0.2% -0.477*** 2009 1 Full immunization 48.0% 61.3% 61.9% 57.9% 64.3% 56.1% 0.065** Skilled antenatal care (4+ visits) 73.7% 89.0% 90.1% 94.5% 95.6% 87.3% 0.057*** Skilled birth attendance 74.8% 94.1% 94.9% 98.5% 97.9% 89.8% 0.066*** contraceptive prevalence 51.3% 51.4% 52.9% 49.6% 53.3% 51.8% 0.002 19 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1=2009 Guyana demographic and Health Survey, 2= 2006-07 Guyana Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Guyana. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: un Photo/ciganovic 20 HealtH equity and Financial Protection dataSHeet haiti the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1a,1b,1c,2,3 q1 q2 q3 q4 q5 total ci in HealtH 2000 1b outcoMeS infant mortality rate 113.3 81.5 101.2 86.9 98.1 96.3 -0.025 under-five mortality rate 186.1 134.4 135.6 127.4 130.8 144.7 -0.067** Stunting 37 .1% 34.3% 27.1% 21.5% 9.1% 27.3% -0.194*** underweight 20.7% 14.5% 15.5% 10.1% 5.3% 13.9% -0.198*** diarrhea 27 .3% 25.4% 30.1% 28.4% 21.5% 26.8% -0.012 acute respiratory infection 48.6% 45.8% 38.7% 39.6% 29.6% 41.4% -0.078*** Fever 49.3% 48.4% 39.4% 38.9% 30.3% 42.2% -0.083*** 2005-06 1c infant mortality rate 79.2 76.6 83.0 62.1 43.2 71.5 -0.065*** under-five mortality rate 134.5 129.1 117.2 99.8 52.6 113.3 -0.106*** Stunting 38.6% 36.2% 30.4% 20.1% 6.1% 28.1% -0.222*** underweight 21.6% 22.5% 21.5% 13.8% 6.2% 18.0% -0.160*** diarrhea 26.1% 24.9% 24.8% 25.4% 18.0% 24.3% -0.043** acute respiratory infection 32.2% 33.6% 29.1% 25.6% 21.9% 29.0% -0.071*** Fever 30.0% 30.3% 28.5% 28.7% 23.7% 28.6% -0.028* adult HealtH1a,1b,1c,3 q1 q2 q3 q4 q5 total ci 1994-95 1a obesity among non-pregnant 0.8% 1.0% 0.0% 2.5% 11.7% 2.7% 0.582*** women 2000 1b obesity among non-pregnant 1.0% 1.7% 4.7% 10.2% 15.1% 7.9% 0.414*** women 2005-06 1c obesity among non-pregnant 0.6% 1.8% 3.1% 7.1% 13.0% 6.2% 0.437*** women HiV positive 2.1% 1.8% 2.3% 3.4% 1.5% 2.2% -0.006 inequalitieS in riSk FactorS1a,1b.1c,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2005-06 1c Smoking (women) 4.6% 3.5% 2.9% 2.3% 3.4% 3.2% -0.066 concurrent partnerships 11.2% 14.4% 18.1% 22.9% 26.9% 19.8% 0.171*** condom usage (more than 6.1% 9.8% 17.7% 23.7% 39.7% 25.0% 0.293*** one partner) 21 inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1,2 utiliZation 2000 1b Full immunization 25.6% 30.6% 42.3% 31.1% 42.3% 33.8% 0.101*** treatment of diarrhea 32.5% 37.1% 42.8% 49.0% 44.9% 40.8% 0.087*** treatment of diarrhea 33.5% 33.1% 43.4% 38.9% 50.3% 37.9% 0.079*** Skilled antenatal care (4+ visits) 24.9% 32.8% 45.5% 52.9% 73.4% 44.9% 0.215*** Skilled birth attendance 5.1% 8.8% 13.2% 39.5% 70.2% 24.6% 0.499*** 2005-06 1c Full immunization 33.4% 41.2% 46.1% 35.7% 56.0% 41.4% 0.072*** treatment of diarrhea 32.9% 38.6% 48.7% 53.0% 54.9% 43.9% 0.124*** Medical treatment of ari 14.7% 18.5% 27.2% 36.1% 41.4% 24.8% 0.221*** Skilled antenatal care (4+ visits) 32.1% 43.4% 54.0% 64.9% 82.5% 54.0% 0.188*** Skilled birth attendance 6.7% 10.8% 20.4% 42.7% 66.7% 26.3% 0.447*** contraceptive prevalence 34.2% 41.6% 41.5% 44.3% 43.7% 42.0% 0.033*** note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1a=1994-95 Haiti demographic and Health Survey, 1b=2000 Haiti demographic and Health Survey, 1c=2005-06 Haiti demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Haiti. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: un Photo/eskinder debebe 22 HealtH equity and Financial Protection dataSHeet honduras the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 2005-06 1 outcoMeS infant mortality rate 39.2 36.3 25.2 21.6 18.6 29.4 -0.150*** under-five mortality rate 53.8 53.7 40.0 27.5 26.2 42.0 -0.143*** Stunting 50.2% 37 .7% 25.0% 14.3% 7.7% 29.5% -0.309*** underweight 16.0% 9.9% 6.5% 3.3% 2.4% 8.4% -0.362*** diarrhea 19.4% 17.8% 17.4% 12.1% 10.3% 15.9% -0.119*** acute respiratory infection 19.8% 21.1% 17.1% 14.5% 12.3% 17.4% -0.095*** Fever 19.6% 19.8% 18.3% 16.6% 14.4% 18.0% -0.059*** adult HealtH1,3 q1 q2 q3 q4 q5 total ci 2005-06 1 obesity among non-pregnant 7.5% 13.2% 20.7% 24.4% 24.0% 19.0% 0.181*** women inequalitieS in riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2005-06 1 Smoking (women) 0.6% 0.9% 1.7% 2.8% 4.4% 2.3% 0.368*** concurrent partnerships 3.3% 4.8% 6.1% 7.5% 6.8% 5.9% 0.134*** condom usage (more than 6.8% 13.5% 21.5% 21.9% 20.7% 18.9% 0.107*** one partner) inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1,2 utiliZation 2005-06 1 Full immunization 77.2% 77.2% 77.9% 74.5% 70.6% 75.9% -0.013 treatment of diarrhea 56.7% 53.4% 61.8% 56.2% 48.4% 56.2% -0.008 Medical treatment of ari 43.3% 50.2% 53.9% 62.3% 70.5% 53.1% 0.092*** Skilled antenatal care (4+ visits) 55.9% 65.7% 75.5% 85.3% 95.2% 74.6% 0.107*** Skilled birth attendance 32.8% 51.0% 78.0% 89.4% 98.4% 66.6% 0.217*** contraceptive prevalence 30.2% 36.9% 40.0% 40.7% 38.0% 37.6% 0.035*** 23 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1=2005-06 Honduras demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Honduras. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: un Photo/Mark Garten 24 HealtH equity and Financial Protection dataSHeet Me x ico the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 2002-03 3 outcoMeS diarrhea 30.2% 22.7% 25.3% 20.0% 31.5% 26.3% -0.018 acute respiratory infection 20.8% 20.1% 22.5% 24.1% 18.9% 21.2% 0.004 Fever 61.5% 59.7% 60.0% 59.6% 63.4% 60.8% 0.004 Malaria 0.8% 0.4% 1.7% 0.5% 0.8% 0.8% 0.028 adult HealtH1,3 q1 q2 q3 q4 q5 total ci 2002-03 3 tuberculosis 12.6% 13.6% 14.4% 13.7% 14.8% 13.7% 0.025* obesity among non-pregnant 14.1% 16.3% 18.9% 17.2% 14.8% 16.2% 0.027 women road traffic accident 1.1% 1.1% 1.6% 2.3% 2.5% 1.7% 0.203*** non-road traffic accident 4.9% 5.9% 6.3% 7.0% 6.4% 6.1% 0.056*** angina 1.8% 2.0% 1.9% 3.0% 2.8% 2.3% 0.105*** arthritis 3.9% 4.0% 4.3% 5.3% 5.3% 4.6% 0.074*** asthma 2.1% 2.5% 2.9% 3.4% 3.2% 2.8% 0.100*** depression 3.0% 3.9% 6.0% 6.0% 7.4% 5.3% 0.177*** diabetes 3.4% 5.3% 6.3% 7.0% 5.4% 5.4% 0.100*** difficulty with work and 4.2% 3.8% 4.1% 4.3% 2.7% 3.8% -0.056*** household activities Poor self-assessed health 6.8% 6.7% 6.0% 5.6% 3.7% 5.8% -0.100*** status riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci inequalitieS in 2002-03 3 riSky BeHaVior Smoking (all) 18.9% 21.6% 25.3% 26.2% 30.4% 24.5% 0.097*** Smoking (women) 8.8% 12.0% 15.9% 17 .8% 26.3% 16.1% 0.216*** insufficient physical activity 39.0% 36.3% 31.8% 30.5% 29.5% 33.4% -0.063*** drinking 2.1% 2.3% 2.5% 2.9% 3.3% 2.6% 0.092*** concurrent partnerships 1.3% 1.2% 1.6% 1.0% 4.2% 1.7% 0.235** inequalitieS adult PreVentiVe care2,3 q1 q2 q3 q4 q5 total ci in HealtH care 2002-03 3 utiliZation tB screening 2.8% 3.1% 3.6% 3.2% 4.4% 3.4% 0.063** Voluntary counseling and 62.0% 76.6% 77.6% 81.9% 77.0% 76.1% 0.030 testing for HiV cervical cancer screening 83.0% 85.0% 83.7% 85.6% 85.2% 84.5% 0.005 Breast cancer screening 11.3% 16.7% 20.3% 23.7% 30.7% 21.2% 0.180*** 25 inequalitieS adult curatiVe care3 q1 q2 q3 q4 q5 total ci in HealtH care 2002-03 3 utiliZation inpatient or outpatient (cont.) 61.9% 64.0% 65.0% 65.3% 65.7% 64.4% 0.013*** (12 months) inpatient (12 months) 6.6% 7.8% 8.2% 7.5% 7.2% 7.5% 0.015 inpatient (5 years) 17.1% 18.0% 19.4% 19.5% 18.7% 18.5% 0.022** outpatient (12 months) 58.5% 59.1% 59.7% 59.6% 59.0% 59.2% 0.004 threshold share of total household consumption Financial cataStroPHic out-oF- 5% 10% 15% 25% 40% Protection Pocket SPending 2002-03 3 Headcount 16.7% 13.1% 10.0% 5.9% 3.4% concentration index 0.184*** 0.157*** 0.140*** 0.124*** 0.080** threshold share of nonfood consumption cataStroPHic out-oF- 5% 10% 15% 25% 40% Pocket SPending 2002-03 3 Headcount 26.9% 25.8% 24.4% 21.8% 18.6% concentration index 0.029*** 0.016** -0.003 -0.041*** -0.084*** iMPoVeriSHMent Poverty line at uS$1.25 per consumption consumption change % change capita per day including ooP excluding ooP 2002-03 3 Percentage in poverty 26.2% 27.8% 1.6 pp 6.2% average shortfall from the $0.14 $0.15 $0.01 6.5% poverty line average shortfall from the $0.55 $0.55 $0.00 0.3% poverty line, among the poor Poverty line at uS$2.00 per consumption consumption change % change capita per day including ooP excluding ooP 2002-03 3 Percentage in poverty 44.8% 47.4% 2.6 pp 5.9% average shortfall from the $0.41 $0.44 $0.03 6.2% poverty line average shortfall from the $0.92 $0.93 $0.00 0.4% poverty line, among the poor note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. Poverty lines are at 2005 purchasing power parity, adjusted to current prices using Mexico’s consumer price index. data sources: 1=n/a demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=2002-03 Mexico World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Mexico. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: curt carnemark 26 HealtH equity and Financial Protection dataSHeet Nicaragua the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1a,1b,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1998 1a outcoMeS infant mortality rate 54.1 53.8 47.5 39.4 27.9 46.8 -0.088*** under-five mortality rate 66.6 70.0 57.6 53.9 40.0 59.6 -0.073*** Stunting 44.8% 36.2% 28.9% 19.9% 12.5% 31.4% -0.210*** underweight 16.1% 11.8% 10.7% 6.5% 3.9% 10.9% -0.222*** diarrhea 16.4% 14.2% 15.1% 14.3% 8.9% 14.3% -0.078*** acute respiratory infection 29.9% 28.5% 25.3% 27 .6% 21.5% 27.2% -0.046*** Fever 26.6% 23.8% 25.0% 22.7% 17 .3% 23.8% -0.059*** 2001 1b infant mortality rate 53.0 43.7 30.4 27.1 14.2 36.7 -0.206*** under-five mortality rate 65.9 53.4 43.6 35.1 17.5 46.7 -0.187*** Stunting 41.7% 31.5% 20.4% 10.8% 6.0% 24.9% -0.316*** underweight 12.9% 8.5% 5.8% 4.6% 3.1% 7.7% -0.273*** diarrhea 15.6% 14.5% 13.8% 11.5% 8.5% 13.3% -0.099*** acute respiratory infection 35.7% 35.8% 31.6% 28.0% 24.0% 31.9% -0.073*** Fever 26.4% 28.5% 25.5% 22.4% 21.6% 25.3% -0.041*** adult HealtH1a,1b,3 q1 q2 q3 q4 q5 total ci 1998 1a obesity among non-pregnant 5.7% 11.1% 14.5% 16.7% 17.5% 13.8% 0.159*** women 2001 1b obesity among non-pregnant 7.6% 13.5% 19.3% 23.1% 21.9% 18.2% 0.151*** women inequalitieS in riSk FactorS1a,1b,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2001 1b Smoking (women) 2.2% 3.0% 4.2% 5.5% 9.5% 5.3% 0.293*** concurrent partnerships 3.1% 4.7% 4.9% 6.1% 7.9% 5.6% 0.178*** condom usage (more than 8.1% 9.3% 9.4% 11.7% 16.0% 12.1% 0.159** one partner) 27 inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1a,1b,2 utiliZation 1998 1a Full immunization 62.4% 76.5% 77.2% 86.2% 79.6% 74.6% 0.061*** treatment of diarrhea 57.0% 59.6% 49.9% 55.4% 55.4% 55.7% -0.014 Medical treatment of ari 45.6% 56.8% 62.6% 67.6% 73.6% 58.0% 0.100*** Skilled antenatal care (4+ visits) 42.1% 60.8% 68.5% 77.1% 86.4% 63.2% 0.144*** Skilled birth attendance 34.1% 60.5% 80.9% 87.9% 92.8% 66.1% 0.199*** 2001 1b Full immunization 55.7% 76.1% 68.7% 61.4% 66.1% 65.3% 0.018 treatment of diarrhea 51.8% 57.1% 57.7% 54.4% 48.2% 54.2% 0.002 Medical treatment of ari 45.5% 60.2% 64.7% 58.9% 74.5% 57.9% 0.091*** Skilled antenatal care (4+ visits) 48.3% 69.0% 77.6% 85.9% 90.2% 72.6% 0.120*** Skilled birth attendance 30.0% 62.1% 83.9% 91.3% 97.6% 67.7% 0.219*** contraceptive prevalence 65.1% 69.9% 70.1% 69.9% 66.9% 68.5% -0.000 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1a=1998 nicaragua demographic and Health Survey, 1b=2001 nicaragua demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - nicaragua. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Jaime Martin 28 HealtH equity and Financial Protection dataSHeet Paraguay the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1990 1 outcoMeS infant mortality rate 46.9 35.7 47.5 37.1 12.5 37.3 -0.109*** under-five mortality rate 69.7 51.3 59.0 45.7 14.9 50.7 -0.145*** Stunting 26.7% 23.4% 20.9% 8.9% 4.2% 18.2% -0.251*** underweight 4.0% 3.6% 3.3% 1.4% 0.7% 2.8% -0.238*** diarrhea 4.1% 4.7% 5.2% 4.7% 2.8% 4.3% -0.006 acute respiratory infection 36.5% 42.5% 45.4% 42.8% 34.7% 40.3% 0.022 Fever 37 .0% 35.0% 33.9% 26.4% 22.0% 31.7% -0.083*** 2002-03 3 diarrhea 23.3% 22.9% 21.8% 21.6% 26.6% 23.1% 0.022 acute respiratory infection 31.8% 25.4% 20.0% 36.4% 27.5% 28.2% -0.023 Fever 78.4% 76.2% 68.6% 69.4% 59.7% 72.6% -0.045** Malaria 0.9% 1.9% 1.0% 0.5% 0.0% 0.9% -0.389*** adult HealtH1,3 q1 q2 q3 q4 q5 total ci 2002-03 3 tuberculosis 9.1% 7.7% 8.4% 6.5% 6.2% 7.6% -0.074** obesity among non-pregnant 9.2% 8.9% 9.8% 16.6% 10.7% 11.4% 0.064 women road traffic accident 1.5% 1.1% 2.7% 1.4% 1.0% 1.6% -0.040 non-road traffic accident 5.5% 7.0% 7.1% 8.9% 7.7% 7.3% 0.078** angina 5.1% 6.3% 6.0% 6.6% 5.2% 5.8% 0.005 arthritis 3.1% 3.4% 5.0% 4.9% 5.3% 4.4% 0.113** asthma 3.1% 5.2% 6.9% 5.7% 8.3% 5.9% 0.161*** depression 3.0% 5.1% 7.1% 8.2% 10.4% 6.8% 0.202*** diabetes 2.3% 4.2% 5.6% 5.4% 6.8% 4.9% 0.165*** difficulty with work and 4.2% 4.1% 5.4% 2.8% 2.2% 3.7% -0.119** household activities Poor self-assessed health 3.9% 2.4% 3.5% 2.5% 1.3% 2.7% -0.152*** status riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci inequalitieS in 2002-03 3 riSky BeHaVior Smoking (all) 39.7% 29.7% 26.1% 19.6% 20.1% 26.9% -0.150*** Smoking (women) 14.3% 12.6% 8.0% 8.5% 13.7% 11.3% -0.017 insufficient intake of fruit and 60.5% 64.3% 67.0% 69.0% 72.1% 66.7% 0.033*** vegetables insufficient physical activity 28.3% 26.4% 19.7% 19.1% 19.7% 22.6% -0.089*** drinking 17.9% 15.3% 14.1% 14.2% 10.7% 14.4% -0.092*** concurrent partnerships 0.6% 1.9% 2.9% 0.7% 1.9% 1.6% 0.071 29 inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1,2 utiliZation 1990 1 Full immunization 20.0% 31.3% 37.4% 40.4% 52.9% 34.3% 0.203*** treatment of diarrhea 27.7% 27.8% 35.0% 31.7% 35.5% 30.5% 0.068 Medical treatment of ari 48.1% 54.5% 70.7% 81.1% 75.1% 63.7% 0.114*** Skilled antenatal care (4+ visits) 35.7% 51.7% 66.4% 85.1% 93.9% 63.2% 0.205*** Skilled birth attendance 41.1% 50.5% 70.5% 87.9% 98.1% 66.3% 0.192*** adult PreVentiVe care2,3 q1 q2 q3 q4 q5 total ci 2002-03 3 tB screening 0.2% 1.1% 2.7% 1.4% 3.0% 1.7% 0.286*** cervical cancer screening 72.1% 84.2% 83.6% 85.3% 88.7% 84.0% 0.029*** Breast cancer screening 2.6% 6.5% 8.7% 11.7% 31.9% 13.4% 0.425*** adult curatiVe care3 q1 q2 q3 q4 q5 total ci 2002-03 3 inpatient or outpatient 49.0% 52.6% 59.5% 63.1% 76.0% 60.3% 0.091*** (12 months) inpatient (12 months) 5.8% 6.4% 7.1% 6.6% 6.7% 6.5% 0.024 inpatient (5 years) 17.0% 21.4% 23.2% 21.2% 24.3% 21.4% 0.061*** outpatient (12 months) 50.0% 53.2% 59.4% 63.3% 78.4% 60.8% 0.093*** threshold share of total household consumption Financial cataStroPHic out-oF- 5% 10% 15% 25% 40% Protection Pocket SPending 2003 3 Headcount 39.9% 26.9% 18.3% 9.5% 4.2% concentration index 0.099*** 0.113*** 0.157*** 0.209*** 0.303*** threshold share of nonfood consumption cataStroPHic out-oF- 5% 10% 15% 25% 40% Pocket SPending 2003 3 Headcount 57.2% 48.9% 41.9% 32.6% 23.3% concentration index 0.011 -0.007 -0.031*** -0.043*** -0.096*** iMPoVeriSHMent Poverty line at uS$1.25 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Percentage in poverty 13.0% 15.4% 2.4 pp 18.1% average shortfall from the $0.05 $0.07 $0.01 22.3% poverty line average shortfall from the $0.42 $0.43 $0.01 3.5% poverty line, among the poor Poverty line at uS$2.00 per consumption consumption change % change capita per day including ooP excluding ooP 2003 3 Percentage in poverty 29.2% 33.7% 4.4 pp 15.2% average shortfall from the $0.21 $0.25 $0.04 17.4% poverty line average shortfall from the $0.73 $0.75 $0.01 2.0% poverty line, among the poor 30 note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. Poverty lines are at 2005 purchasing power parity, adjusted to current prices using Paraguay’s consumer price index. data sources: 1=1990 Paraguay demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=2002-03 Paraguay World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Paraguay. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. 31 HealtH equity and Financial Protection dataSHeet peru the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1a,1b,1c,2,3 q1 q2 q3 q4 q5 total ci in HealtH 1996 1a outcoMeS infant mortality rate 83.5 56.6 36.7 36.5 20.0 52.9 -0.233*** under-five mortality rate 121.4 83.5 51.8 56.9 19.0 76.6 -0.244*** Stunting 51.5% 36.9% 24.2% 13.5% 8.3% 31.1% -0.294*** underweight 12.2% 5.6% 3.0% 1.3% 1.5% 5.7% -0.436*** diarrhea 21.6% 20.7% 18.4% 14.2% 9.4% 18.1% -0.121*** acute respiratory infection 25.2% 21.9% 19.0% 18.4% 13.7% 20.7% -0.098*** Fever 34.7% 30.0% 27 .2% 23.9% 18.0% 28.3% -0.108*** 2000 1b infant mortality rate 66.9 57.8 31.1 25.2 14.7 44.9 -0.251*** under-five mortality rate 104.5 89.6 44.8 28.6 16.0 66.8 -0.288*** Stunting 54.2% 37 .4% 21.2% 11.8% 7.1% 31.2% -0.327*** underweight 11.4% 4.7% 2.5% 1.6% 1.2% 5.3% -0.440*** diarrhea 18.7% 18.1% 16.3% 11.2% 7.6% 15.5% -0.132*** acute respiratory infection 21.4% 21.5% 20.7% 18.1% 18.4% 20.4% -0.033*** Fever 31.3% 28.0% 26.2% 20.6% 17 .7% 26.1% -0.100*** 2004-08 1c infant mortality rate 42.0 33.8 21.2 15.0 9.8 27.5 -0.263*** under-five mortality rate 60.6 51.1 31.8 22.1 15.5 40.8 -0.251*** Stunting 51.7% 38.0% 16.9% 12.4% 6.1% 28.4% -0.352*** underweight 9.6% 5.8% 2.2% 1.3% 1.0% 4.6% -0.415*** diarrhea 16.9% 15.5% 14.4% 11.0% 8.5% 14.0% -0.117*** acute respiratory infection 23.4% 18.6% 17 .3% 17 .2% 16.3% 19.1% -0.078*** Fever 29.4% 25.1% 23.2% 21.2% 21.4% 24.7% -0.073*** adult HealtH1a,1b,1c,3 q1 q2 q3 q4 q5 total ci 1996 1a obesity among non-pregnant 3.0% 7.3% 11.6% 13.5% 16.1% 9.6% 0.275*** women 2000 1b obesity among non-pregnant 3.6% 9.7% 15.9% 17.9% 14.1% 13.0% 0.154*** women 2004-08 1c obesity among non-pregnant 5.0% 12.2% 17.0% 17.8% 15.0% 14.2% 0.111*** women 32 inequalitieS in riSk FactorS1a,1b,1c,2,3 q1 q2 q3 q4 q5 total ci riSky BeHaVior 2004-08 1c Smoking (women) 1.4% 1.7% 4.2% 7.4% 13.2% 6.1% 0.414*** concurrent partnerships 4.3% 6.7% 10.2% 13.8% 18.4% 11.3% 0.257*** condom usage (more than 8.6% 16.0% 23.5% 29.6% 38.8% 29.1% 0.174*** one partner) inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interVentionS1a,1b,1c,2 utiliZation 1996 1a Full immunization 55.7% 64.0% 64.4% 72.0% 66.8% 63.4% 0.048*** treatment of diarrhea 26.9% 29.2% 22.0% 29.7% 16.5% 26.2% -0.024 Medical treatment of ari 36.1% 44.9% 51.7% 57.2% 58.0% 46.0% 0.111*** Skilled antenatal care (4+ visits) 16.0% 41.6% 60.6% 74.8% 89.7% 49.5% 0.300*** Skilled birth attendance 14.0% 49.2% 75.7% 90.9% 97.0% 57.4% 0.315*** 2000 1b Full immunization 51.2% 50.3% 63.6% 64.5% 63.6% 57.2% 0.063*** treatment of diarrhea 36.6% 30.7% 39.8% 27.2% 44.4% 35.0% -0.003 Medical treatment of ari 47.2% 51.0% 61.7% 68.9% 79.3% 57.8% 0.101*** Skilled antenatal care (4+ visits) 40.7% 59.1% 76.8% 88.5% 93.7% 68.2% 0.168*** Skilled birth attendance 17.0% 45.5% 79.6% 93.6% 98.4% 58.5% 0.316*** 2004-08 1c Full immunization 48.7% 52.9% 52.8% 58.8% 60.7% 53.7% 0.044*** treatment of diarrhea 31.3% 32.3% 44.4% 44.3% 59.8% 38.3% 0.120*** Medical treatment of ari 64.6% 68.2% 63.5% 71.9% 67.2% 66.5% 0.012 Skilled antenatal care (4+ visits) 72.9% 85.8% 92.9% 95.5% 97.1% 87.6% 0.059*** Skilled birth attendance 44.0% 75.1% 93.3% 97.8% 99.3% 77.4% 0.160*** contraceptive prevalence 51.6% 52.9% 53.7% 52.0% 49.9% 52.0% -0.009* note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1a=1996 Peru demographic and Health Survey, 1b=2000 Peru demographic and Health Survey, 1c=2004-08 Peru demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Peru. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Scott Wallace 33 HealtH equity and Financial Protection dataSHeet Suriname the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS cHild HealtH1,2,3 q1 q2 q3 q4 q5 total ci in HealtH 2006 2 outcoMeS Stunting 16.9% 10.0% 8.2% 7.8% 4.4% 10.6% -0.256*** underweight 9.4% 6.7% 6.5% 7.2% 5.6% 7.4% -0.107** diarrhea 16.6% 9.2% 8.2% 7.6% 7.3% 10.7% -0.198*** acute respiratory infection 15.0% 12.4% 11.4% 10.9% 12.1% 12.7% -0.068** inequalitieS in riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci riSky BeHavior 2006 2 concurrent partnerships 4.7% 3.1% 6.6% 10.2% 7.6% 6.5% 0.174*** inequalitieS Maternal and cHild q1 q2 q3 q4 q5 total ci in HealtH care HealtH interventionS1,2 utiliZation 2006 2 contraceptive prevalence 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.899*** adult Preventive care2,3 q1 q2 q3 q4 q5 total ci 2006 2 voluntary counseling and 87.9% 89.1% 91.0% 93.0% 92.1% 90.7% 0.009*** testing for Hiv note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. data sources: 1=n/a demographic and Health Survey, 2=2006 Suriname Multiple indicator cluster Survey, 3=n/a World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - Suriname. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth.s 34 HealtH equity and Financial Protection dataSHeet UrUgUay the Health equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. data are drawn from the demographic and Health Surveys (dHS), World Health Surveys (WHS), Multiple indicator cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. the datasheets use a common set of health indicators for all countries. all analyses are conducted using the health modules of the adePt software. inequalitieS adult HealtH1,3 q1 q2 q3 q4 q5 total ci in HealtH 2002-03 3 outcoMeS tuberculosis 4.2% 2.8% 2.0% 4.7% 2.8% 3.3% -0.026 road traffic accident 2.4% 1.3% 1.4% 0.7% 1.0% 1.4% -0.180* non-road traffic accident 3.1% 3.3% 3.2% 2.0% 3.8% 3.1% -0.011 angina 4.2% 5.6% 5.6% 6.2% 4.9% 5.3% 0.016 arthritis 12.5% 10.3% 8.6% 6.0% 5.5% 8.6% -0.171*** asthma 7.0% 8.2% 7.9% 8.3% 10.0% 8.3% 0.064 depression 9.7% 12.0% 12.0% 15.8% 8.7% 11.7% 0.006 diabetes 4.6% 7.0% 3.6% 6.4% 3.7% 5.1% -0.034 difficulty with work and 3.6% 2.6% 1.7% 1.7% 1.1% 2.2% -0.206*** household activities Poor self-assessed health 4.0% 3.5% 2.8% 2.2% 0.2% 2.6% -0.281*** status riSk FactorS1,2,3 q1 q2 q3 q4 q5 total ci inequalitieS in 2002-03 3 riSky BeHaVior Smoking (all) 36.6% 34.8% 35.0% 30.7% 30.7% 33.5% -0.043* insufficient intake of fruit and 75.4% 73.2% 71.6% 71.7% 66.7% 71.7% -0.023*** vegetables insufficient physical activity 49.3% 48.8% 44.5% 42.6% 41.8% 45.4% -0.031* drinking 2.8% 4.8% 2.8% 3.8% 5.6% 4.0% 0.132* inequalitieS adult PreVentiVe care2,3 q1 q2 q3 q4 q5 total ci in HealtH care 2002-03 3 utiliZation tB screening 2.2% 1.7% 0.9% 3.5% 0.8% 1.8% -0.045 Voluntary counseling and 96.5% 74.6% 97.9% 97.4% 87.8% 91.1% 0.003 testing for HiV cervical cancer screening 76.3% 82.7% 89.3% 90.1% 89.7% 86.7% 0.027*** Breast cancer screening 35.7% 43.6% 51.2% 64.4% 72.1% 54.4% 0.137*** adult curatiVe care3 q1 q2 q3 q4 q5 total ci 2002-03 3 inpatient or outpatient 47.8% 51.4% 54.1% 57.1% 63.4% 54.8% 0.059*** (12 months) inpatient (12 months) 8.6% 6.0% 4.5% 4.5% 3.3% 5.4% -0.197*** inpatient (5 years) 20.7% 19.5% 17.2% 17.9% 15.2% 18.1% -0.060** outpatient (12 months) 39.2% 41.3% 47.9% 46.3% 51.0% 45.2% 0.053*** 35 threshold share of total household consumption Financial cataStroPHic out-oF- 5% 10% 15% 25% 40% Protection Pocket SPending 2002-03 3 Headcount 27.1% 17.0% 11.1% 3.9% 1.0% concentration index 0.247*** 0.260*** 0.240*** 0.033 -0.442*** threshold share of nonfood consumption cataStroPHic out-oF- 5% 10% 15% 25% 40% Pocket SPending 2002-03 3 Headcount 32.9% 26.1% 20.7% 11.0% 5.3% concentration index 0.208*** 0.185*** 0.178*** 0.188*** 0.017 iMPoVeriSHMent Poverty line at uS$1.25 per consumption consumption change % change capita per day including ooP excluding ooP 2002-03 3 Percentage in poverty 2.4% 2.5% 0.2 pp 7.4% average shortfall from the $0.01 $0.01 $0.00 6.6% poverty line average shortfall from the $0.49 $0.49 -$0.00 -0.7% poverty line, among the poor Poverty line at uS$2.00 per consumption consumption change % change capita per day including ooP excluding ooP 2002-03 3 Percentage in poverty 7.4% 7.6% 0.2 pp 2.7% average shortfall from the $0.05 $0.05 $0.00 4.0% poverty line average shortfall from the $0.61 $0.62 $0.01 1.4% poverty line, among the poor note: the Health equity and Financial Protection datasheets use a standardized selection of indicators (see Measurement of indicators for full list). When (1) data sources are not available or (2) indicator-specific sample size is less than 250 per quintile for mortality indicators or less than 25 per quintile for all others, indicators are not reported for the country under analysis. For analysis of inequalities using WHS, dHS and MicS, quintile ranking is based on an asset index. For all other analyses, ranking is based on household consumption. q = quintile (where quintile 1 is the poorest) ci = concentration index; ranges between -1 and 1; negative sign indicates that the health outcome takes higher values among the poor * Significant at 10%, **Significant at 5%, ***Significant at 1%. Poverty lines are at 2005 purchasing power parity, adjusted to current prices using uruguay’s consumer price index. data sources: 1=n/a demographic and Health Survey, 2=n/a Multiple indicator cluster Survey, 3=2002-03 uruguay World Health Survey. recommended citation: World Bank. 2012. Health equity and Financial Protection datasheet - uruguay. Washington, d.c.: World Bank. For more information and the latest versions of the Health equity and Financial Protection reports and datasheets, see: www.worldbank.org/povertyandhealth. Photo credit: Francis dobbs 36 I nterpre tatIon of results InequalItIes In health outcomes, rIsky behavIor and health care utIlIzatIon the tables in this section show how health outcomes, risky behaviors and health care utilization vary across asset (wealth) quintiles and periods. the quintiles are based on an asset index constructed using principal components analysis. the tables show the mean values of the indicator for each quintile, as well as for the sample as a whole. also shown are the concentration indices which capture the direction and degree of inequality. a negative value indicates that the variable (e.g. stunting or skilled birth attendance) is more concentrated among the poor, while a positive value indicates that the variable is concentrated among the better off. the larger the index in absolute size, the more inequality there is. the statistical significance of the concentration index is also shown, at 1% (***), 5% (**) and 10% (*) significance levels. For example, if stunting has a concentration index of -0.121***, then stunting is significantly concentrated among the poor. beneFIt-IncIdence analysIs benefit-incidence analysis (bIa) shows whether, and by how much, government health expenditure disproportionately benefits the poor. there are three tables showing, respectively, the distribution of service utilization across consumption quintiles for different types of care, the distribution of user fees, and the distribution of the estimated subsidies. all tables also show the concentration indices which capture the direction and degree of inequality. a negative value indicates that the variable (i.e. utilization, fees or subsidies) is more concentrated among the poor, while a positive value indicates that the variable is concentrated among the better off. the larger the index in absolute size, the greater is the inequality. For example, if the concentration index of subsidies to hospitals is positive, the non-poor benefit more than the poor from government spending on hospital services. the distribution of subsidies depends on the assumptions made to allocate subsidies to households. under the constant unit cost assumption, each unit of utilization is assumed to cost the same and is equal to total costs incurred in delivering this type of service (i.e. subsidies plus user fees) divided by the number of units of utilization. under the constant unit subsidy assumption, the unit subsidy is assumed to be constant, equal to total subsidies for the service in question divided by the number of units of utilization of that service. under the proportional cost assumption, higher fees are indicative of a more costly type of care; specifically, it is assumed that unit costs and fees are proportional to one another. If the concentration index is negative, then the subsidy to the particular level of care is pro-poor and if the concentration index is positive, then the subsidy is pro-rich. the column labeled “share� shows the distribution of the total subsidy across different levels of care. FInancIal protectIon: catastrophIc and ImpoverIshIng expendIture measures of financial protection relate out-of-pocket spending to a threshold. one approach is to classify spending as ‘catastrophic’ if it exceeds a certain fraction of household income or consumption or nonfood consumption. catastrophic payments are defined as health care payments in excess of a predetermined percentage (i.e. 5% to 40%) of their total household spending or nonfood spending. the first line of the first table shows the catastrophic payment “headcount�, i.e. the proportion of households with a health payment budget share greater than the given threshold. For example, if the “headcount� figure given in the last column of the first table is 6%, then 6% of households spend more than 40% of their pre-payment income on health payments. the concentration indices in the second line of each table show whether there is a greater tendency for the better off to have out-of-pocket spending in excess of the payment threshold (in which case it takes on a positive value), or whether the poor are more likely to have out-of-pocket spending exceeding the threshold (in which case it takes on a negative value). another approach is to classify health spending as ‘impoverishing’ if it is sufficiently large to make the household cross the poverty line, i.e. the household would not have been poor had it been able to use for general consumption the money it was forced to spend on health care. the extent of impoverishment due to health care expenditure is measured by comparing the extent of poverty computed using household consumption gross and net of out-of-pocket health spending. the table shows three measures of poverty. the first line of the table shows the percentage of the population living below the poverty line, i.e. the poverty “headcount�. the second line shows the population’s average shortfall from the poverty line, i.e. the “normalized poverty gap�; the normalization is useful when making comparisons across countries with different poverty lines and currency units. Finally, the last line shows the average shortfall from the poverty line, among those who are poor, i.e. the normalized mean positive poverty gap. the last column shows the percentage increase in poverty, the percentage increase in the average shortfall from the poverty line and the percentage increase in the average shortfall from the poverty line among the poor due to out-of-pocket health spending, respectively. progressIvIty oF health FInancIng the table in this section reports whether overall health financing, as well as the individual sources of finance, is regressive (i.e. a poor household contributes a larger share of its resources than a rich one), progressive (i.e. a poor household contributes a smaller share of its resources than a rich one) or proportional. the 1st through 5th columns show the distribution of consumption and different sources of health care financing. the 6th column shows the summary measures of inequality; in the case of consumption, this is the gini coefficient and in the case of other sources of financing it is the concentration index. In the 7th column, the kakwani index (defined as the concentration index less the gini coefficient) takes on a positive value, then payments are more concentrated among the better off than consumption, and is a sign that payments are progressive. If the kakwani index is negative, then payments are regressive. the last column shows the contribution of each financing source to total health care financing (obtained from national health accounts data). For more guIdance on InterpretatIon oF results, see: o’donnell, o., e. van doorslaer, a. Wagstaff and m. lindelow. (2008). analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, d.c.: World bank. Wagstaff, a., m. bilger, z. sajaia and m. lokshin. (2011). health equity and financial protection: streamlined analysis with adept software. Washington, d.c.: World bank. Me asureMent of In dIcators IndIcator MeasureMent data chIld health number of deaths among children under 12 months of age per 1,000 live births (note: mortality Infant mortality rate rate calculated using the true cohort life table approach; the dhs reports use the synthetic cohort dhs life table approach) number of deaths among children under 5 years of age per 1,000 live births (note: mortality rate under-five mortality rate calculated using the true cohort life table approach; the dhs reports use the synthetic cohort life dhs table approach) % of children with a height-for-age z-score <-2 standard deviations from the reference median stunting dhs, MIcs (note: z-score calculated using Who 2006 child Growth standards) % of children with a weight-for-age z-score <-2 standard deviations from the reference median underweight dhs, MIcs (note: z-score calculated using Who 2006 child Growth standards) diarrhea % of children with diarrhea (past two weeks) dhs, MIcs diarrhea % of children with diarrhea (past two weeks; youngest child) Whs acute respiratory infection % of children with an episode of coughing and rapid breathing (past two weeks) dhs, MIcs acute respiratory infection % of children with an episode of coughing and rapid breathing (past two weeks; youngest child) Whs Fever % of children with fever (past two weeks) dhs, MIcs Fever % of children with fever (past two weeks; youngest child) Whs Malaria % of children with an episode of malaria (past year; youngest child) Whs adult health tuberculosis % of adults who reported tuberculosis symptoms (past year) Whs obesity among non-pregnant women % of women aged 15 to 49 with a BMI above 30 dhs obesity among all women % of women aged 18 to 49 with a BMI above 30 Whs road traffic accident % of adults involved in a road traffic accident with bodily injury (past year) Whs % of adults who suffered bodily injury that limited everyday activities, due to a fall, burn, poisoning, non-road traffic accident Whs submersion in water, or by an act of violence (past year) angina % of adults ever diagnosed with angina or angina pectoris Whs arthritis % of adults ever diagnosed with arthritis Whs asthma % of adults ever diagnosed with asthma Whs depression % of adults ever diagnosed with depression Whs diabetes % of adults ever diagnosed with diabetes Whs difficulty with work and household % of adults who have severe or extreme difficulties with work or household activities (past 30 days) Whs activities (note: this indicator was created from an ordinal variable with five categories) % of adults who rate own health as bad or very bad (note: this indicator was created from an Poor self-assessed health status Whs ordinal variable with five categories) hIV Positive Percentage of adults aged 15 to 49 whose blood tests are positive for hIV 1 or hIV 2. dhs rIsk Factors smoking (all) % of adults who smoke any tobacco products such as cigarettes, cigars or pipes Whs smoking (women) % of women aged 15 to 49 who smoke cigarettes, pipe or other tobacco dhs smoking (women) % of women aged 18 to 49 who smoke cigarettes, pipe or other tobacco Whs Insufficient intake of fruit and vegetables % of adults who have insufficient intake of fruit/vegetables (less than 5 servings) Whs Insufficient physical activity % of adults who spend < 150 minutes on walking/ moderate activity/vigorous activity (past week) Whs drinking % of adults who consume ≥5 standard drinks on at least one day (past week) Whs concurrent partnerships % of women aged 15 to 49 who had sexual intercourse with more than one partner (past year) dhs, MIcs concurrent partnerships % of women aged 18 to 49 who had sexual intercourse with more than one partner (past year) Whs % of women aged 15 to 49 who had more than one partner in the past year and used a condom condom usage (more than one partner) dhs, MIcs during last sexual intercourse % of women aged 18 to 49 who had more than one partner in the past year and used a condom condom usage (more than one partner) Whs during last sexual intercourse Mosquito net use by children % of children who slept under an (ever) insecticide treated bed net (Itn) (past night) dhs, MIcs % of pregnant women aged 15 to 49 who slept under an (ever) insecticide treated bed net (Itn) Mosquito net use by pregnant women dhs (past night) Maternal and chIld health InterVentIons % of children aged 12-23 months who received BcG, measles, and three doses of polio and dPt, Full immunization dhs, MIcs either verified by card or by recall of respondent treatment of diarrhea % of children with diarrhea given oral rehydration salts (ors) or home-made solution dhs, MIcs % of children with a cough and rapid breathing who sought medical treatment for acute respiratory Medical treatment of arI dhs, MIcs infection (past 2 weeks) % of mothers aged 15 to 49 who received at least 4 antenatal care visits from any skilled personnel skilled antenatal care (4+ visits) dhs (doctor, nurse/midwife, auxiliary midwife, feldsher, family nurse, trained birth attendant) skilled birth attendance % of mothers aged 15 to 49 that were attended by any skilled personnel at child’s birth dhs contraceptive prevalence % of women aged 15 to 49 who currently use a modern method of contraception dhs, MIcs adult PreVentIVe care tB screening % of adults who were tested for tuberculosis (past year) Whs Voluntary counseling and testing for hIV % of women aged 18 to 49 who were tested for hIV and were told the results of the test Whs,MIcs cervical cancer screening % of women aged 18 to 69 who received a pap smear during last pelvic examination (past 3 years) Whs Breast cancer screening % of women aged 40 to 69 who received a mammogram (past 3 years) Whs adult curatIVe care Inpatient or outpatient (12 months) % of adults who used any inpatient or outpatient health care (past year) Whs Inpatient (12 months) % of adults who used any inpatient health care (past year) Whs Inpatient (5 years) % of adults who used any inpatient health care (past 5 years) Whs % of adults who used any outpatient health care (past year; conditional on having not used any outpatient (12 months) Whs inpatient care past 5 years) note: unless otherwise noted, all children are under the age of 5 and all adults are aged 18 and older About the Health Equity and Financial Protection datasheets The Health Equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the Demographic and Health Surveys, World Health Surveys, Multiple Indicator Cluster Surveys, Living Standards and Measurement Surveys, as well as other household surveys, and use a common set of health indicators for all countries in the series. All analyses are conducted using the health modules of the ADePT software. Also available are Health Equity and Financial Protection country reports. The most recent versions of the Health Equity and Financial Protection reports and datasheets can be downloaded at www.worldbank.org/povertyandhealth.