Global evidence on inequities in rural health protection 19
Figure 15. The rural staff access deficit and maternal mortality, selected countries, 2015
Source: ILO estimates, 2015.
3.6. The size of global ruralurban inequities
Globally, rural populations experience considerably lower levels of health coverage and access to health care than urban populations. As we have seen earlier
figure 1, 22 per cent of the urban population worldwide are not affiliated to a health scheme or system, compared to 56 per cent of the rural population. Thus, more than half the global
rural population is deprived of the right to access health care when in need.
A similar level of exclusion is found as regards the coverage gap due to the lack of health workers sufficient to provide quality care: 52 per cent of the rural population lack such
access as compared to 24 per cent of the urban population. Large inequities are also observed as regards the financial deficit and maternal
mortality ratios that burden the rural population about twice as much as the urban. OOP seem to be less inequitable; however, the detailed analyses above reveal that the
extent of rural OOP is closely linked to non-access to services as compared to the urban OOP that reflect higher utilization rates.
Figure 16 brings together these findings to show the global deficit in effective access to health services among both rural and urban populations.
Brazil, Moldova Somalia
Indonesia Viet Nam
50 100
150 200
250
20 40
60 80
100 120
M a
te rn
a l
d e
a th
s p
e r
1 ,0
l iv
e b
ir th
s
Staff Access Deficit, Threshold 41.1
20 Global evidence on inequities in rural health protection
Figure 16. The global deficit in effective access to health services, urban and rural populations, 2015 percentages
Notes: OOP = out-of-pocket expenditure, MMR = maternal mortality ratio. Regional averages weighted by urban and rural population, except for MMR which is weighted by urban and rural skilled birth attendants.
Source: ILO estimates, 2015.
When breaking down these results by region figure 17 we find similar features, except for regions with a significant number of high-income countries:
Virtually all the legal, staff access and financial deficits occur among rural populations. The inequities in OOP are relatively smaller, except for Latin America and the Caribbean.
Maternal mortality ratios are regionally most important in Africa, but are also significant in other regions.
22 24
33 41
11 56
52
63 42
29 20
40 60
80 Estimate of legal coverage
deficit as a of total population
Coverage gap due to health professional staff deficit
threshold: 41.1
Financial deficit threshold: US239
OOP expenditure as of total health expenditure
Maternal mortality ratio per 10,000 live births
Urban Rural
Global evidence on inequities in rural health protection 21
Figure 17. Regional deficits in effective access to health services, urban and rural populations, 2015 percentages
Notes: OOP = out-of-pocket expenditure, MMR = maternal mortality ratio. Regional averages weighted by urban and rural population, except for MMR which is weighted by urban and rural skilled birth attendants.
Against this background, it can be concluded that: No single action focusing on only one of the areas highlighted by the indicators can solve the
issues observed: it is necessary to apply a comprehensive and systematic approach that addresses issues within the health systems
simultaneously − mainly the lack of rights, health workers, funding, financial protection and quality. Thus, extending health protection and
related equitable access to all is key. Further, the close relationship between gaps in access to health care and the socio-economic
characteristics of the rural population need to be considered when searching for sustainable solutions to address the health protection deficits and gaps experienced by rural populations,
in order to minimize the impacts of inequities deriving from issues beyond the health sector.
20 40
60 80
100 Legal
coverage deficit
Staff access deficit
Financial deficit
OOP as of total health
expenditure MMR per
10,000 births
Africa 44 countries
20 40
60 80
100 Legal
coverage deficit
Staff access deficit
Financial deficit
OOP as of total health
expenditure MMR per
10,000 births
Latin America Caribbean 30 countries
20 40
60 80
100 Legal
coverage deficit
Staff access deficit
Financial deficit
OOP as of total health
expenditure MMR per
10,000 births
Asia the Pacific 30 countries
20 40
60 80
100 Legal
coverage deficit
Staff access deficit
Financial deficit
OOP as of total health
expenditure MMR per
10,000 births
Middle East 12 countries
Urban Rural
22 Global evidence on inequities in rural health protection
3.7. Inequities in rural and urban areas at national level: Selected country studies
