Assessing urban-rural inequality in the primary healthcare system readiness to provide postpartum care for mothers and newborns in Burkina Faso: a Gini index decomposition analysis.

Abstract

Background: Maternal and neonatal mortality have declined significantly in sub-Saharan Africa (SSA). Postpartum care is one of the most neglected components of healthcare. It still drives maternal and neonatal mortality in SSA. Studies have shown a gap between urban and rural areas in terms of maternal and newborn healthcare (MNHC) services, including postpartum care utilization. However, little is known about the gap in postpartum care provision. Our study aimed to assess urban‒rural inequalities in healthcare system preparedness to provide postpartum care for mothers and newborns in Burkina Faso.

Methods: We analyzed data from the National Harmonized Health Facilities Assessment (HHFA) survey conducted in all health facilities (HFs) in 2020 in Burkina Faso. Only health facilities of primary level of healthcare were included. The availability of and readiness for postpartum care for mothers and newborns were analyzed using the World Health Organization (WHO) HHFA guidelines. The Gini index was used to assess urban-rural inequalities. It was decomposed in overall Gini index which measures the inequality based on the all the primary healthcare facilities and within-group Gini index which quantifies the inequality within each subgroup (urban and rural areas).

Results: Out of 2115 HFs, 387 were in urban areas (18.3%). All postpartum services for mothers and newborns were available in 58.4% of the HFs in urban areas versus 83.9% in rural areas (p < 0.001). The overall readiness score was 58.4% (52.1% in urban areas compared with 59.8% in rural areas; p < 0.001). The urban‒rural differences in readiness were primary driven by difference in staff and guidelines domain (36.3% and 42.3%, p < 0.001) and the medicines and products domain (55.2% and 70.6%, p < 0.001). The differences were also significant for the first point of contact with the healthcare system (health centers: 52.9% and 59.8%, p < 0.001). The overall Gini index was 0.167 (95% CI: [0.161-0.172]), with a higher inequality index for private HFs and hospitals. The within-group Gini index was higher in urban areas (0.204 [95% CI: 0.190-0.219]) than rural areas (0.145 [95% CI: 0.139-0.150]).

Conclusion: Our findings suggest an overall lower readiness score for the postpartum care, with a low overall and within urban and rural areas inequality. Even low, reducing these inequalities might help to provide high-quality postpartum care for all mothers and newborns regardless of their place of residence.