Social Dimensions of Inequalities in East Africa

Under five mortality rates

child-mortality-rate-under-5

Despite the gap between the wealthiest and poorest quintiles, the under-five mortality rates have decreased over time. Rwanda has made significant progress in reducing under-five mortality rates that has benefited the poor. The under-five mortality rates amongst the poorest quintiles in Rwanda went down from 211 deaths per 1,000 live births to 119 deaths in a five-year period.

Infant mortality rates

Infants in East Africa’s poorest families have higher mortality rates than those in the richest families. In the most recent surveys, poor families in Uganda have the highest infant mortality rates in the region at 76 deaths per 1,000 live births. By contrast, Uganda’s richest households have the region’s lowest infant mortality rates. Poor families in Tanzania have the lowest infant mortality rates among East Africa’s poorest households with 61 deaths per 1,000 live births.

infant-mortality-rate

Infant mortality rates have decreased significantly across the wealth quintiles, demonstrating progress made in improving infant healthcare. Though poor families in Uganda had the highest infant mortality rates in the previous and latest surveys, it still reduced its infant mortality from 172 deaths per 1,000 live births to 76, a significant achievement. Rwanda also reduced infant mortality rates among the poorest families from 114 to 70 deaths per 1,000 live births. There were no increases of infant mortality rates across wealth quintiles.

Differences in malnutrition between rich and poor children

Vaccination covers the majority of the population across wealth quintiles. From Table 8 and Table 9 below, which examine BCG (a vaccine for tuberculosis) and polio-3 immunization coverage, two trends are visible. The first is that polio vaccine coverage for the poorest 20 per cent, for example, improved from between 56 per cent (Uganda) and 82 per cent (Rwanda) in the earlier surveys to between 61 per cent (Uganda) and 97 per cent (Rwanda) more recently. Secondly, the gap in coverage between the rich and poor has closed between the earliest and more recent surveys. In Rwanda, the most recent survey shows that polio coverage was higher among the poorest 20 per cent of the population than the wealthiest 20 per cent, by six percentage points.

Table 9. Stunting across wealth quintiles in Burundi (2010)

STUNTB

Source: Burundi Enquête Démographique et de Santé 2010

There have been just two surveys conducted in Burundi, the latest one being in 2010 after a two-decade break. The most recent data shows that 70 per cent of children in Burundi’s lowest wealth quintile are stunted compared to 41 per cent of children in its wealthiest quintile. This is the highest prevalence of stunting in East Africa and it is twice as high as Uganda’s 37 per cent prevalence of stunting amongst its poorest children.

Table 10. Stunting across wealth quintiles in Kenya (2003 and 2010)

stunting

Source: Kenya Demographic and Health Survey (2003 and 2010)

Kenya’s young children are also increasingly stunted as the national data shows. Children in the wealthiest quintile had a one in four chance of being stunted in 2010 compared to a one in five chance in 2003. Children in the poorest quintile, were already twice as likely to be stunted as their wealthier compatriots in 2003. While this rich-poor gap had closed slightly by 2010, 44 per cent of Kenya’s poorest children were stunted in 2010, an increase of six percentage points from 2003.

Table 11. Stunting across wealth quintiles in Rwanda (2005 and 2010)

stuntR

Source: Rwanda Demographic and Health Survey (2005 and 2010)

In Rwanda, there has been a marginal improvement in stunting rates among the poorest quintile where more than 50 per cent of the children are stunted. Among the wealthiest quintile, the probability of children being stunted declined from one third to one quarter. The gap between Rwanda’s wealthiest and poorest in this indicator has widened from 25 to 28 percentage points.

Table 12. Stunting across wealth quintiles in Tanzania (2004 and 2010)

 STUNTDT

Source: Tanzania Demographic and Health Survey (2005 and 2010)

Tanzania’s malnutrition trend data are disturbing. Stunting has increased across the board, amongst both the wealthiest and poorest quintiles. Between 2004 and 2010, the probability of a child in the wealthiest quintile being stunted went from 16 per cent to 26 per cent. Among the poorest Tanzanians just under half of the children are stunted in 2010.

Table 13. Stunting across wealth quintiles in Uganda (2006 and 2011)

 STUNTU

Source: Uganda Demographic and Health Survey (2006 and 2011)

Malnutrition in Uganda has declined between 2006 and 2011, but it did so fastest among the poorest wealth quintiles where it went from 43 per cent to 37 per cent, compared to the wealthiest quintile where it dropped from 24 per cent to 20 per cent.

Health service delivery indicators for Tanzania and Kenya

In Tanzania 60 per cent of urban health facilities have electricity, clean water and improved sanitation compared to just 5 per cent of rural facilities. In Kenya 58 per cent of health facilities in urban areas share the same advantage of infrastructure. The starkest differences between public and private health facilities in Kenya were seen in infrastructure availability with 49 per cent access in public facilities and 86 per cent in private ones.

Table 14. Health services delivery indicators in Tanzania (2012)

Indicator Rural Urban National
Infrastructure

(facilities with electricity, clean water and improved sanitation)

5%

60%

19%

Medical equipment per clinic

76%

83%

78%

Stock‐out of drugs

24%

23%

24%

Absence rate of medical personnel

17%

33%

21%

Diagnostic accuracy

53%

68%

57%

Process quality

31%

44%

35%

Time spent counselling patients per clinician (per day)

26 min

36 min

29 min

Primary Health Expenditure per capita Reaching Primary Clinics

6%

11%

7%

Delays in Salaries

2%

3%

2%

Source: World Bank Service Delivery Indicators Education and Health Services in Tanzania (2013)

Tanzania’s urban health facilities do better in their diagnostic accuracy (68 per cent) compared to rural ones (53 per cent), but less well than in Kenya where diagnostic accuracy is a high 70-75 per cent across the board. Interestingly, medical personnel in urban Kenya and Tanzania are more likely to be absent from their health facilities than their rural counterparts.

Table 15. Health services delivery indicators in Kenya (2012)

Indicator Public Private Rural Public Urban Public All
Number of outpatient visits per clinician per day

9

10

8.5

10

9

Absence from facility

29%

21%

28%

38%

28%

Diagnostic Accuracy (Share of correct diagnoses)

72%

74%

75%

71%

72%

Adherence to clinical guidelines

43%

48%

42%

52%

44%

Management of maternal /neonatal complications

44%

46%

43%

49%

45%

Drug availability

67%

69%

67%

63%

67%

Equipment availability

72%

92%

71%

87%

76%

Infrastructure availability[23]

49%

86%

48%

58%

57%

Source: World Bank Service Delivery Indicators Education and Health services in Kenya (2013)

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23Defined as share of facilities with electricity, clean water and improved sanitation.

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