WP 551 'Self-reported health care seeking behavior in rural Ethiopia: Evidence from clinical vignettes'

ISS Working Paper by Anagaw Mebratie, Ellen van de Poel, Zelalem Debebe, Degnet Abebaw, Getnet
Alemu and Arjun S. Bedi

Abstract

Between 2000 and 2011, Ethiopia rapidly expanded its health-care infrastructure recording
an 18-fold increase in the number of health posts and a 7-fold increase in the number of
health centers. However, annual per capita outpatient utilization has increased only
marginally. The extent to which individuals forego necessary health care, especially why and
who foregoes care are issues that have received little attention in the context of low-income
countries.

This paper uses five clinical vignettes covering a range of context-specific child
and adult-related diseases to explore the health-seeking behavior of rural Ethiopian
households. We find almost universal preference for modern care. There is a systematic
relationship between socioeconomic status and choice of providers mainly for adult-related
conditions with households in higher consumption quintiles more likely to seek care in
health centers, private/NGO clinics as opposed to health posts. Similarly, delays in careseeking
behavior are apparent mainly for adult-related conditions. The differences in care
seeking behavior between adult and child related conditions may be attributed to the recent
spread of health posts which have focused on raising awareness of maternal and child health.

Overall, the analysis suggests that the lack of health-care utilization is not driven by the
inability to recognize health problems or due to a low perceived need for modern care but
due to other factors.

Keywords
Health care seeking behavior; Ethiopia, clinical vignettes, foregone care.

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