Social Determinants of Equity in Access to Healthcare for Tuberculosis Patients in Republic of Macedonia – Results from a Case-Control Study

Abstract

Background: Health is a complex phenomenon and equity as a basic human right an integral part of constitutions in almost all countries in the world. In Republic of Macedonia (RM), Tuberculosis (TB) is clustered regionally and in certain ethnic groups. The main objective of this study was to analyze Social Determinants of Health (SDH) and equity in access to healthcare services for TB patients in RM, aimed at complex analysis of factors that cause inequities. Methods: Case-control study was conducted in the period March-December, 2013; “cases” are households of TB patients registered in the period July, 2012-June, 2013 and controls are households with no TB patients in their immediate vicinity. World Health Organization (WHO) World Health Survey questionnaire was used to collect data. Results: Analysis of SDH of TB patients shows that patients are mostly males, of lower socio-economic status, are less educated, unemployed and TB is clustered in certain ethnic groups. Analysis of access has identified these determinants as important barriers in access to health services. Conclusion: The study has documented the basic SDH of TB patients in RM, as well as barriers in access to healthcare, providing useful baseline information to facilitate determination where to concentrate future efforts.

Keywords: Equity; Social Determinants of Health (SDH); Tuberculosis (TB) Patients; Macedonia