Use of Medical Care: How People in Informal Employment Rate Access to Health Services 2.2.1 Use of medical care – disparities between countries The answers to our question indicate major differences and allow us to rank the six countries according to the perceived availability of medical care(Figure 2.1). In Kenya and Zambia, a majority of nearly 70 per cent declared that medical care is always or mostly available when needed. Around 10 per cent still feel marginalised, however, in that they could hardly obtain medical care. In Senegal and Benin, 30 and 32 per cent, respectively, face a situation that prevents them usually or always from obtaining medical care when needed. In these countries, the share of those who mostly or always go without medical care is nearly three times higher than in Kenya and Zambia. The other two countries occupy a middle position, with Côte d’Ivoire leaning towards Benin and Senegal and Ethiopia being closer to Kenya and Zambia. Concerning the perceived availability of medical care we can talk of an East African/West African gap. Respondents from Benin, Senegal and Côte d’Ivoire rate the availability of medical care lower than respondents from Kenya, Zambia and Ethiopia. 2.2.2 Use of medical care – inequality by urban/rural residence The residence factor confirms the existence of a country ranking in relation to the use of medical care. In Kenya and Zambia, living location is of minor or no importance for the use of medical care. 5 Judging from our surveys, Kenya and Zambia appear to have overcome the rural/urban divide in this regard(Figure 2.2). In Senegal, Benin and Côte d’Ivoire, the living environment becomes a distorting factor. While in urban locations, some 44 to 56 per cent of respondents confirm regular use of med­ical care, this is the case for only 25 to 38 per cent of rural residents. Ethiopia reports a similar gap between urban and rural residents. Resort to medical care in Ethiopia, however, is ensured at a higher level for both groups, so that the relative use gap – which we could call the urban/rural discrimination factor – is lower. 2.2.3 Use of medical care – inequality by gender To obtain an understanding of gender sensitivity in relation to the use of medical services, we divided our sample into male- and female-led households. The head of household answered the question for all members without giving sepa­rate accounts for male and female members. 6 Figure 2.3 reproduces the responses according to the sex of the head of household. None of the countries shows a significant disparity in the use of medical care between male­led and female-led households. Senegal and Côte d’Ivoire just miss the significance level, while the other four countries show a high level of conformity. With the data generated from our surveys therefore we are unable to assess whether the sex of the household head influences the use of medical care within the household. 5 We have simplified the data appraisal by putting the five-answer op­tions into two groups. If people have»never« or»only once or twice« gone without medicine or medical treatment, we call it»regular use of medical care«; if people have»mostly« or»always« gone without medicine or medical treatment, we call it»low use of medical care«. The middle category of»several times« is ignored. 6 We assume that both male and female heads do not apply a bias when assessing cases of sicknesses in their households. Thus, the ­responses can be taken as an approximation for assessing the ­gender-related use of medical services. Figure 2.1 Use of medical care 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 32.4% 28.0% 39.6% Benin 30.2% 34.8% 34.9% 23.9% 29.2% 46.9% 17.5% 19.6% 62.9% Senegal Côte d'Ivoire Ethiopia 12.5% 19.4% 68.1% Zambia 10.0% 21.7% 68.3% Kenya regular use sometimes low use Question:»Over the past year, how often, if ever, have you or anyone in your family ›gone without medicines or medical treatment‹?« Answer options: never; just once or twice; sometimes; many times; always. Note: Households are included only if they reported cases of sickness during past 12 months. Definitions: regular use of medical care=»gone without medical care«: never or just once or twice; low use of medical care=»gone without medical care«: many times, or always. 9