Support Team - Equity and Health: lessons from the SPHIP seminar in Stockholm

The SPHIP programme is part of the EU programme of contributing to the Sustainable Development Goals (SDGs) and strengthening capacity for health systems development. In this context, achieving of Universal Health Coverage (UHC) and equity in health are important themes. SPHIP project representatives exchanged views in a seminar in November 2017 in Stockholm, analysing of the contributions of the projects to improving equity in health. (read more)

The participants in the workshop identified vulnerable groups in the countries where SPHIP projects take place: the poor, people living in remote areas, people with low levels of education, or people with insecure incomes. Also, people in urban slums were mentioned several times, as well as specific groups like, the ageing population, chronically ill, disabled people, street children, ethnic minorities. While there are some general measures possible for all groups in society to enhance equity, like financial accessibility, there are specific measures needed addressing the special needs of vulnerable groups, targeted in SPHIP projects.

The AAAQ framework shows the priority areas, which participants on the workshop identified:

• Accessibility: geographic accessibility is for rural populations an important issue, especially when mobility is limited.
• Affordability: in all countries, affordability came up as important, especially for urban people living in slums. Insurance schemes that are developed in several countries as UHC projects, may assist people with employment, but often not the self-employed persons. Innovative schemes supporting the most vulnerable groups should be developed in UHC.
• Acceptability: cultural issues, discrimination, and stigmatisation were mentioned as issues to be addressed. UHC is therefore broader than removing financial and physical barriers to access.
• Quality: often the quality of health services and human resources are addressed in UHC. In addition,  non-existent services may have to be incorporated in the public health system, e.g. NCD prevention and control at primary health care level or disability services. Quality is about a comprehensive package of services, not only the existing services.

While some of the SPHIP projects have a clear focus on equity issues, defined in their Description of Work e.g. targeting urban poor or chronically ill, or addressing healthcare financing, others have more difficulties in showing how they contribute to strengthening equity. Some projects were not conceived with an equity focus. They do not have specific equity targets in their logical frameworks.

However, indirectly all projects can contribute to equity. For example, in education programmes in health, equity can be taught to students, and equity and gender training activities can be incorporated.

In research, equity questions can be included. It requires that the researchers are alert and formulate the relevant research questions. In public health, the concepts of social determinants of health are frequently used to investigate equity issues.

Interestingly, some projects bring vulnerable groups on board in priority setting for research, e.g. with the formation think tanks, alliances, or coalitions involving community groups and stakeholders.

Also, accountability to the people is an instrument for enhancing equity, with examples of the PIGA and Lao PDR and the Policy Implementation Barometer. Strengthening health management information systems and data for decision making, community involvement in data analysis are other elements of accountability that can be considered as part of achieving UHC.

Conclusion

SPHIP projects can make a substantial contribution to equity and Universal Health Coverage in their countries, directly (through the topics addressed) or indirectly through research and education. In research, it requires awareness that the correct questions are asked with regards to vulnerable groups and equity. In education, it requires good formulation of the curriculum, to address the relevant topics.

Inclusion of vulnerable groups in priority setting in UHC and accountability is a strong instrument in enhancing equity.

Dr. Jaap Koot – Team Leader SPHIP Support Team