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Inequalities in healthcare resources and outcomes threatening sustainable health development in Ethiopia: panel data analysis
  1. Abraha Woldemichael1,2,
  2. Amirhossein Takian1,3,4,
  3. Ali Akbari Sari1,
  4. Alireza Olyaeemanesh1,4,5
  1. 1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran (the Islamic Republic of)
  2. 2 School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
  3. 3 Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  4. 4 Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  5. 5 National Institute for Health Research, Tehran, Iran (the Islamic Republic of)
  1. Correspondence to Dr Amirhossein Takian; takian{at}


Objective To measure inequalities in the distributions of selected healthcare resources and outcomes in Ethiopia from 2000 to 2015.

Design A panel data analysis was performed to measure inequalities in distribution of healthcare workforce, infrastructure, outcomes and finance, using secondary data.

Setting The study was conducted across 11 regions in Ethiopia.

Participants Regional population and selected healthcare workforce.

Outcomes measured Aggregate Theil and Gini indices, changes in inequalities and elasticity of healthcare resources.

Results Despite marked inequality reductions over a 16 year period, the Theil and Gini indices for the healthcare resources distributions remained high. Among the healthcare workforce distributions, the Gini index (GI) was lowest for nurses plus midwives (GI=0.428, 95% CI 0.393 to 0.463) and highest for specialist doctors (SPDs) (GI=0.704, 95% CI 0.652 to 0.756). Inter-region inequality was the highest for SPDs (95.0%) and the lowest for health officers (53.8%). The GIs for hospital beds, hospitals and health centres (HCs) were 0.592(95% CI 0.563 to 0.621), 0.460(95% CI 0.404 to 0.517) and 0.409(95% CI 0.380 to 0.439), respectively. The interaction term was highest for HC distributions (47.7%). Outpatient department visit per capita (GI=0.349, 95% CI 0.321 to 0.377) and fully immunised children (GI=0.307, 95% CI 0.269 to 0.345) showed inequalities; inequality in the under 5 years of age mortality rate increased overtime (P=0.048). Overall, GI for government health expenditure (GHE) was 0.596(95% CI 0.544 to 0.648), and the estimated relative GHE share of the healthcare workforce and infrastructure distributions were 46.5% and 53.5%, respectively. The marginal changes in the healthcare resources distributions were towards the advantaged populations.

Conclusion This study revealed high inequalities in healthcare resources in favour of the advantaged populations which can hinder equal access to healthcare and the achievements of healthcare outcomes. The government should strengthen monitoring mechanisms to address inequalities based on the national healthcare standards.

  • ethiopia
  • gini index
  • healthcare outcomes
  • healthcare resources
  • inequality
  • inequality decomposition

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  • Patient consent for publication Not required.

  • Contributors AW contributed in developing the concept, analysing the data and interpreting the findings, and in the write up of the manuscript. AT contributed from the beginning in the development of the concept, in shaping the entire work and in intellectual development and continuous review of the manuscript. He is the guarantor. AAS participated in developing and refining the methodology, and revising the manuscript. AO participated in developing the methodology and interpretation of the findings.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study was based on publicly available data. The retrieved datasets are available from the corresponding author on reasonable request.