Self-reported health care seeking behavior in rural Ethiopia: Evidence from clinical vignettes

Between 2000 and 2011, Ethiopia rapidly expanded its health-care infrastructure recording an 18-fold increase in the number of health posts and a 7-fold increase in the number of health centers. However, annual per capita outpatient utilization has increased only marginally. The extent to which individuals forego necessary health care, especially why and who foregoes care are issues that have received little attention in the context of low-income countries. This paper uses five clinical vignettes covering a range of context-specific child and adult-related diseases to explore the health-seeking behavior of rural Ethiopian households. We find almost universal preference for modern care. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centers, private/NGO clinics as opposed to health posts. Similarly, delays in care-seeking behavior are apparent mainly for adult-related conditions. The differences in care seeking behavior between adult and child related conditions may be attributed to the recent spread of health posts which have focused on raising awareness of maternal and child health. Overall, the analysis suggests that the lack of health-care utilization is not driven by the inability to recognize health problems or due to a low perceived need for modern care but due to other factors.