Healthcare Utilization in the Context of the Implementation of Universal Health Coverage and COVID 19: Evidence from the Household Living Standards Survey, Côte d’Ivoire

Universal Health Coverage was established to reduce financial barriers to healthcare. Nevertheless, inequalities in access—including cases of forgoing care—persist. This study analyzes the determinants of healthcare utilization in Côte d'Ivoire using data from the 2021 Harmonized Survey on Household Living Conditions. This study aims to analyse healthcare utilization in Côte d'Ivoire in the dual context of Universal health coverage scheme (CMU in Côte d’Ivoire) and the COVID-19 pandemic. The individual was taken as the unit of analysis. The analytical sample comprised 64,491 individuals drawn from 12,965 households. Analyses of healthcare utilization were restricted to the 17,220 individuals who reported a health problem in the preceding 30 days. Both the type of care sought and instances of forgone care were recorded. Logistic regression was used to assess associations between sociodemographic, socioeconomic and health-related characteristics and healthcare utilization. Among respondents, 11,017 (64.0%) had sought medical care, whereas 6,203 (36.0%) had renounced despite reporting a health problem. Self-medication was the principal reason for forgoing care. Healthcare utilization was positively associated with younger age (AOR = 2.50; 95% CI [2.03-3.08]), the presence of a chronic condition (AOR = 2.14; 95% CI [1.88-2.45]) and health insurance enrolment, particularly under the UHC scheme (AOR = 2.93; 95% CI [1.86-4.61]). Conversely, primary school education (AOR = 0.83; 95% CI [0.76-0.90]) and living in a household size with one person (AOR = 0.78; 95% CI [0.63-0.96]) were associated with lower odds of seeking care. Neither self-reported COVID-19 infection nor area of residence (rural versus urban) was significantly associated with healthcare utilization. Inequalities in access to care persist despite the introduction of CMU. Strengthening universal access will require both a broader benefit package for people living with chronic conditions and sustained action on health literacy.