InegSante: Tackling inequalities in health and access to healthcare in African and Middle Eastern countries, challenges of measurement and explanation

The INEGSANTE research project was directly related to themes 4 (Catastrophe, risks, vulnerabilities) and 1 (Demographic dynamics and future of societies in developing countries) of the call for proposals ‘les Suds Aujourd’hui II’. It aimed at improving the scientific debate about equity in healthcare expenditures and in access to healthcare in developing countries in three related ways:

  • Providing decomposition and microsimulation techniques that are appropriate for disentangling the respective roles of individual behaviours and preferences and of characteristics of healthcare delivery systems and financing schemes in the analysis of equity.

  • Re-examining the relationship between income and healthcare inequalities, notably with an attempt to operationalise in this field Sen’s concepts of ‘adaptive preferences and capability deprivation’ and through measuring ex post re-ranking effects of healthcare expenditures on income distribution.

  • Performing econometric analysis applying, for the first time, these approaches to national household surveys including detailed data on healthcare expenditures and consumption in a large sample of 12 African and Middle Eastern low-income (Burkina-Faso, Senegal, Zambia), lower middle-income (Cameroon, Côte d’Ivoire, Egypt, Jordan, Morocco, Palestine, Tunisia) and upper middle-income (Lebanon, South Africa) countries.

HERU researchers involved in this research project: Ramses Abul Naga

External collaborators: Abu-Zaineh, M., Moatti, J.P., Arrighi, Y., Ventelou, B., Woode, M.E. (Marseille); Boutayeb, A. (University Mohammed Premier, Morocco); Mataria, A. (World Health Organization, Regional Office for the Eastern Mediterranean).


Abu-Zaineh, M. and Abul Naga, R.H. (2013) 'Wealth, health, and the measurement of multidimensional inequality: evidence from the Middle East and North Africa', in Rosa Dias, P. & O'Donnell, O. (eds.) Health & Inequality, Research on Economic Inequality, Volume 21, Emerald Group Publishing, 421-439.