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Social Protection

Building social protection floors and comprehensive social security systems

Inequity in Health Protection: Rural/urban divide

Updated by Xenia Scheil-Adlung on 10.06.2015

Where one lives can unjustly determine health outcomes

As the ILO Social Protection Floors Recommendation, 2012 (No. 202) implies, the location of a household within a country should not play a role in access to health care for those in need. However, due to the concentration of health care facilities and health workers in urban areas, there are considerable and persistent rural/urban inequities in access to health care.

Barriers in access to health care for those living in rural areas become obvious when analysing the urban/rural differences in coverage and utilization rates of health care. At the global level, the percentage of the population covered is negatively correlated with the extent of the rural population. At least 85 per cent of the population is covered in countries where less than 25 per cent are living in rural areas. In contrast, only 15.6 per cent are covered in countries where rural populations exceed 70 per cent.

Global rural population with health-care coverage (percentages)

Source: Scheil-Adlung (2013)

Rural/urban worldwide distribution of physicians and nurses

Source: WHO 2010

Geographical barriers associated with long distances, insufficient road infrastructure and lack of transport translate into additional costs for accessing health services. Such costs can quickly escalate, particularly for patients with chronic diseases who have to seek care regularly. Hence, the place of residence is often an explanation for gaps in effective access to health care. In Tanzania, for example, 44 per cent of women are unable to give birth in a health care facility simply because it is too far from where they live. Also in Cambodia, the number of those not seeking care is higher for those living in rural areas.

Cambodia: Urban and rural household members not seeking treatment, 2005 (percentages)

Note: Ill or injured in the 30 days preceding the Demographic and Health Survey.
Source: ILO 2014 (ESS Paper); DHS Cambodia, 2005.

Main Resources

R202 - Social Protection Floors Recommendation, 2012 (No. 202)