Equity, efficiency and quality of public health care services: spatial planning guidelines for public health care facilities in Nairobi
The basis of this study is the proposition that health care determinants and subsequent utilization of available public health facilities varies throughout socio-economic and geographical settings. Urban informal settlement development follows distinct patterns and unique socioeconomic characteristics that affect population health and associated health care delivery organization. The broad objective of the study was to examine equity, efficiency and quality of public health facilities as spatial planning guidelines for public health care facilities. The study thus presents a framework for investigating how equity, efficiency and quality of public health care services effect the utilization patterns of available health care facilities by income groups. The study first presents a brief overview of prevailing trends of thought regarding health infrastructure planning; equity, efficiency and quality of heath care services and the response to health care consumption by the income groups in Nairobi. The study used three but linked research instruments to collect data both at the facility and the household level. At the facility level, a client exit questionnaire and a facility inventory survey were employed to collect data, while at the household level a structured household questionnaire was used to collect data on household socioeconomic conditions, disease patterns and attendant health care consumption patterns. The study established that public health care consumption varied greatly among the income groups in Nairobi. Its principal argument then emerges from the considerations influencing population health and the socio economic analysis of cases of disease and health care consumption patterns. Further analyses elaborate on determinants of health, equity and their importance as variables in public health facility health care service delivery. The study established that the majority of public health care consumers are the low-income groups, whom the existing facility location depicts a spatial inequity on them. The argument is made that health facilities planning cannot be considered effective and efficient in urban areas without regard to settlement patterns of the different income groups and health care institutional re-organization and the analyses of socio-economic/physical circumstances within which it is embedded. The study critiques the conservative incremental approach that has emerged in health care infrastructure planning despite the tremendous implications it has on the accessibility of health care services to the low - income groups. It recommends that a rationally grounded approach may broaden the horizons for an efficient health care delivery system based on epidemiological and socio economic analyses of disease patterns, economics of health and attendant consumption patterns and the specification of particular target groups.