Background
Malawi is the eleventh poorest country in the world according to UNDP (HDR2010). Health affects poverty and poverty affects health. This paper considers the contribution inequity of health care plays to the health status in Malawi over 19 years from 1992 to the present time.
Methods
Published data prepared by the World Bank and the Malawi Integrated Household Surveys are augmented by analysis of Demographic and Health and Multiple Indicator Cluster Surveys including the latest DHS 2010 survey. Inequalities are identified and quantified using asset scores, wealth quintiles and the equality index – a measure of inequality.
Results
There has been a substantial and enduring improvement in the levels of equality for indicators of health status and the use of health services. Where access is universal, such as EPI, antenatal care and the treatment of pneumonia, the indicators are highly equitable. Where access is improving but not yet universal for services such as skilled birth attendance, family planning and bed net usage the equality indices demonstrate some progress has occurred but show room for further improvement. Underlying determinants offer a mixed picture – some show more inequality such as with fertility and women’s empowerment and some more equality, such as orphan-hood.
Conclusions
Poverty in all its facets is a key underlying cause of ill health in Malawi. Recent efforts to improve access to health care through the Essential Health Package have tended to reduce inequalities. Patience and persistence appears to be having an effect on many of the underlying determinants of health of the poor.