Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey.

Objectives: To assess the inequalities in the access to and quality of care and its related direct payments.

Design: Secondary analysis of the cross-sectional Mozambican Household Budget Survey (HBS).

Setting: Nationally-representative sample of households in Mozambique.

Participants: 11 480 households (58 118 individuals) interviewed during HBS 2014/15.

Intervention: None.

Main Outcome Measures: Equity, utilization of healthcare, access to quality care and direct payments.

Results: About 12.2% of women and 10.1% of men of the survey report a perceive health need. About 72.1% of women and 72.9% men use healthcare. Population in a disadvantaged position living in rural areas have less probabilities of using healthcare for equal health compared to the individuals of a wealthier position and living in urban settings. With regard to quality care, 47.7% women and 46.8% men do not report quality problems. No differences for women's wealth. Men in a disadvantaged position report less chances of accessing quality care compared to men of advantaged position. Also, women and men living in rural areas have less probabilities of accessing quality care. Finally, the majority of people who access healthcare paid 1 Mt during their visit.

Conclusions: This study tackles a fundamental policy concern for health systems of Sub-Saharan Africa and points to areas that urge action to address the existent of socioeconomic and geographical inequalities in the access to and quality of care for women and men, including the strengthening of health facilities in rural and deprived areas to ensure that access to adequate care of acceptable quality is distributed according to need.