ACCESS TO HEALTHCARE FOR SELF-EMPLOYED WORKERS IN MADAGASCAR: ANALYSIS OF THE DETERMINANTS AND IMPACT ON HEALTHCARE USE IN THE ANTANANARIVO-RENIVOHITRA DISTRICT

The health of the self-employed is a key lever for economic and social development in Madagascar. This study explores disparities in access to healthcare between the self-employed and salaried workers, focusing on factors influencing healthcare-seeking behavior. The analysis is based on a survey of 418 participants, including 316 self-employed and 102 salaried workers in the Antananarivo-Renivohitra district. Statistical analyses reveal that distance from health services and lack of health coverage are major barriers to access to care for self-employed. Additionally, in situations where health coverage is unavailable, self-employed workers tend to rely more heavily on self-medication. The applied Multinomial Logit model confirms that factors such as age, distance, income and perception of illness play a significant role in access to care, with significant implications for health policy. These findings highlight the importance of implementing targeted policy measures to enhance healthcare access for self-employed, notably through the expansion of health coverage and the reduction of geographical barriers. Future research should continue to explore strategies for minimizing inequalities in access to healthcare, taking into account the socio-economic specificities of diverse populations.