Health inequity persists, particularly in developing countries. This study explores access to public health care and equity. This descriptive study was conducted using a review of the literature, print media, health reports, and patient experiences. Health accessibility links to equity were analysed, focusing on inequity in healthcare access, challenges in accessing services (long waiting times, non-available pharmaceuticals), poor public health (murder, rape, and other crimes, traffic accidents, traffic congestion, divorce, and unemployment), and misrepresentations of health guidelines. The necessary out-of-pocket spending disfavours the poor and favours the rich who, by purchasing basic health services, have greater access to public health services. The negative public health environment increases the health burden and imposes healthcare requirements which further disfavour the poor in particular, while informal networks favour the rich. Shortfalls in health services and public health necessitate out-of-pocket spending, which also dis-favours the poor and favours the rich.
Health Equity and Access to Health Care in Trinidad and Tobago, World Journal of Public Health.
Vol. 3, No. 3,
2018, pp. 83-92.
World Health Organization. Health Systems Equity. Retrieved November 13, 2017, from http://www.who.int/healthsystems/topics/equity/en/.
United Nations, Office of the High Commissioner for Human Rights. International Covenant on Economic, Social and Cultural Rights. General Assembly resolution. Retrieved November 13, 2017, from http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx.
Gaffoor, G., W. Hosein, Y. Pilgrim, G. Wilson, and G. Frankson. Report of the Commission of Enquiry into the Operation and Delivery of Public Health Care Services in Trinidad and Tobago. Port of Spain: Ministry of Health, 2007.
Ghosh, S. Equity in the utilization of healthcare services in India: evidence from National Sample Survey. Int J Health Policy Manag. 2014; 2 (1):29–38 Retrieved May 25, 2018, from http://ijhpm.com/?_action=articleInfo&article=2804&vol=602
Saito, E., S. Gilmour, D. Yoneoka, G. S. Gautam, M. Rahman, P. K. Shrestha, and K. Shibuya. Inequality and inequity in healthcare utilization in urban Nepal: A cross-sectional observational study. Health Policy Plan. 2016; 31 (7):817–24. Retrieved May 25, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977425/.
PAHO/WHO Country Cooperation Strategy Trinidad and Tobago. Pan American Health Organization Regional Office of the World Health Organization, 2006. Retrieved February 19, 2018, from http://iris.paho.org/xmlui/bitstream/ handle/123456789/5618/ccs_tto_en.pdf.
Health expenditure, private (% of GDP), Trinidad and Tobago. Populationpyramid.net. Retrieved February 21, 2018, from https://www.populationpyramid.net/hnp/health-expenditure-private-of-gdp/2014/trinidad-and-tobago/.
Letter from Geoffrey Lewis, Children’s Life Fund Authority. February 17, 2012.
Singh, H., Haqq ED., Mustapha N. “Patients’ perception and satisfaction with health care professionals at primary care facilities in Trinidad and Tobago.” Bulletin of the World Health Organization. 1999; 77 (4). Retrieved February 5, 2018, from https://monroecollege.edu/uploadedFiles/_Site_Assets/PDF/Patients'%20Perception%20and%20Health.pdf.
Bahall, M. An evaluation of the effectiveness of the decentralized health system in Trinidad and Tobago (unpublished PhD dissertation). The University of the West Indies, St. Augustine, 2010.
65% not happy with Gov’t management of healthcare. Trinidad and Tobago Guardian Newspaper. March 15, 2015. Retrieved February 5, 2018, from http://www.guardian.co.tt/news/2015-03-15/65-not-happy-govt-management-healthcare.
Gwatkin, D. R., A. Bhuiya, and C. G. Victoria. “Making health systems more equitable.” Lancet 2004; 364:1273–80. Retrieved November 30, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/15464189.
Gwatkin, D. R. Are Free Government Health Services the Best Way to Reach the Poor? World Bank, HNP Discussion. 2004; 1–8. Retrieved November 30, 2017, from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.564.1361&rep=rep1&type=pdf.
Phiri, J., and J. E. Ataguba. “Inequalities in public health care delivery in Zambia.” International Journal for Equity in Health. 2014; 13:24. Retrieved November 30, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000893/pdf/1475-9276-13-24.pdf.
McIntyre, D., M. Thiede, G. Dahlgren, and M. Whitehead. “What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?” Soc Sci Med. 2006; 62 (4):858–65. Retrieved November 30, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/16099574.
Kwesiga, B., C. M. Zikusooka, and J. E. Ataguba. “Assessing catastrophic and impoverishing effects of health care payments in Uganda.: BMC Health Services Research. 2015; 15:30. Retrieved November 30, 2017, from https://link.springer.com/content/pdf/10.1186%2Fs12913-015-0682-x.pdf.
Flatø, H., and H. Zhang. “Inequity in level of healthcare utilization before and after universal health coverage reforms in China: Evidence from household surveys in Sichuan Province.” International Journal for Equity in Health. 2016; 15:96 Retrieved December 8, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917991/pdf/12939_2016_Article_385.pdf.
Trinidad and Tobago Corruption Index 2001-2017. Data Chart Calendar. Tradingeconomics.com. Retrieved December 1, 2017, from https://tradingeconomics.com/trinidad-and-tobago/corruption-index.
Top doctor admits to queue-jump. NationalPost. December 3, 2007. Retrieved February 10, 2018, from http://www.nationalpost.com/doctor+admits+queue+jump/141706/story.html.
Koehler, W., M. Fottler, and J. Swan. “Physician-patient satisfaction: Equity in the health services encounter.” Medical Care Review. 1992; 49 (4):455–84. Retrieved February 19, 2018, from http://journals.sagepub.com/doi/abs/10.1177/002570879204900404.
Mayberry, R. M., D. A. Nicewander, H. Qin, and D. J. Ballard. “Improving quality and reducing inequities: A challenge in achieving best care.” Proc (Bayl Univ Med Cent) 2006; 19:103–18. Retrieved February 10, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1426185/pdf/bumc0019-0103.pdf.
Peters, D. H., A. Garg, G. Bloom, D. G. Walker, W. R. Brieger, and M. H. Rahman. “Poverty and access to health care in developing countries.” Ann N Y Acad Sci. 2008; 1136:161–71.
WHO. Patients’ rights. Who.int. Retrieved November 25, 2017, from http://www.who.int/genomics/public/patientrights/en/.
The Ministry of Health, Trinidad and Tobago. Health.gov.tt. Retrieved February 21, 2018, from http://www.health.gov.tt/sitepages/default.aspx?id=114.
Fairer Health: Case Studies on Improving Health for All. Victorian Government Department of Human Services, Melbourne, Victoria, 2009. Retrieved November 13, 2017, from https://www.vichealth.vic.gov.au/~/media/resourcecentre/publicationsandresources/health%20inequalities/fairer_health_web.ashx.
Russo, G., G. Bloom, and D. McCoy. “Universal health coverage, economic slowdown and system resilience: Africa’s policy dilemma.” BMJ Glob Health 2017; 2:e000400. Retrieved November 29, 2017, from http://gh.bmj.com/content/2/3/e000400.