Author's School

Brown School

Author's Department

Social Work

Document Type

Journal Article

Publication Date


Originally Published In

Trani, J. F., & Barbous-des-Couriers, C.(2012). Measuring equity in disability and healthcare utilization in Afghanistan. Medicine, Conflict and Survival, 28(3), 219-246.


This paper analyses equity in health and healthcare utilization in Afghanistan based on a representative national household survey. Equitable access is a cornerstone of the Afghan health policy. We measured socioeconomic-related equity in access to public health care, using disability– because people with disabilities are poorer and more likely to use health care – and a concentration index (CI) and its decomposition. The socioeconomicrelated equity in healthcare utilization was measured using a probit model and compared with an OLS model providing the horizontal inequity index (HI). We found low rate of healthcare facilities utilization (25%). Disabled persons are using more healthcare facilities and have higher medical expenses. Disability is more frequently associated with older age, unemployed heads of household and lower education. The CI of disability is 0.0221 indicating a pro-rich distribution of health. This pro-rich effect is higher in small households (CI decreases with size of the household, -0.0048) and safe (0.0059) areas. The CI of healthcare utilization is -0.0159 indicating a slightly pro-poor distribution of healthcare utilization but overall, there is no difference in healthcare utilization by wealth status. Our study does not show major socioeconomic related inequity in disability and healthcare utilization in Afghanistan. This is due to the extreme and pervasive poverty found in Afghanistan. The absence of inequity in health access is explained by the uniform poverty of the population and the difficulty to access BPHS facilities, despite alarming health indicators.


This is an Accepted Manuscript of an article published by Taylor & Francis in Medicine, Conflict and Survival on 9/2012, available online: