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WWW.EQUITABLEPROJECT.ORG
PROF. MALCOLM MACLACHLAN EQUITABLE PROJECT MANAGER [email protected]
DR. HASHEEM MANNAN EQUITABLE SENIOR RESEARCH FELLOW [email protected]
MS. JOANNE MCVEIGH EQUITABLE RESEARCHER [email protected]
EquitAble and the EquiFrame manual
EquiFrame: A Framework for the Analysis of Human Rights and Vulnerable Groups in Health Policies
How Can a University Change the World?
The Power of ideas can transform
the ideas of Power
Frenk, 1995
EquitAble and the EquiFrame manual
Policies should be written for all but should be sensitive to different types of need
To promote Health for All, focus on equitable health care rather than equal health care
Marginalized, discriminated groups bear a disproportionate share of health problems
States must recognize specific needs of groups that confront particular challenges through disaggregation of health policies
Project EquitAble
o FP7 funded, 4-year collaborative research project; researchers from Ireland, Norway, Sudan, Namibia, Malawi & South Africao Led by Centre for Global Health, Trinity College Dublino Produce empirical knowledge on health care access for vulnerable people in resource poor settings in Africa o 5 Work Packages:
EquiFrame
o Novel policy analytical framework; assesses human rights and social inclusion in health policies
o Assesses policy content or ‘policy on the books’
o Identifies degree of commitment of a health policy to 21 Core Concepts of human rights and 12 Vulnerable Groups, underpinned by ethos of universal, equitable and accessible health service provision
o Particular focus on persons with disabilities (outlined in EquiFrame as a vulnerable group)
o 70 health policies analyzed in total
o 4 target countries: Sudan, Malawi, Namibia, & South Africa: 51 health policies
Impetus
Prevailing focus on process of health policy development; A paucity of literature that outlines an analytical framework to analyze ‘policy on the books’
Many health policy practices developed and researched in higher income countries and subsequently transferred to low- and middle-income (LMIC) countries; Variability of context makes generalization problematic
EquiFrame: A framework to guide policy analysis in terms of ‘policy on the books’ and doing so from a LMIC perspective
Country Profiles
Sudan – Large proportion of population displaced
Malawi – Chronic poverty and high disease burden compete for meagre resources Namibia – Population highly dispersed South Africa – Despite relative wealth, universal and equitable access to health care not yet attained
Development
.Literature Searches/ Discussion
s
Initial Ideas
Project Meeting
Khartoum
Draft Framewor
k
Consultation
Workshops
Revised Framework
Analysis of 70 Health
Policies Results
Feedback workshops
Conference Presentatio
ns
EquiFrame
Universal, Equitable, Accessible
Health Services
Core Concepts
1.Non-discrimination 12.Contribution 2.Individualized services 13.Family resource 3.Entitlement 14.Family support 4.Capability based services 15.Cultural responsiveness 5.Participation 16.Accountability 6.Coordination of services 17.Prevention 7.Protection from harm 18.Capacity building 8.Liberty 19.Access 9.Autonomy 20.Quality 10.Privacy 21.Efficiency 11.Integration
Core Concept Quality
Each Core Concept received a rating of quality of commitment to Core Concept within the given policy document
Score on continuum of 1-4:
1. Concept only mentioned
2. Concept mentioned and explained
3. Specific policy actions identified to address Concept
4. Intention to monitor Concept expressed
Common Health Policies
Policy Malawi Namibia South Africa
Sudan
1 HIV AIDS Policy High Moderate High Low2 Disability Policy Moderate Moderate Low Low4 Tuberculosis Policy Moderate Moderate Moderat
eLow
3 Mental Health Moderate High Moderate
5 Malaria Low Low Low6 National Health policy Low Low High7 Reproductive Health Policy Low Moderate Moderat
e8 Drug/medication Policy Moderate Low9 Gender Policy High Low
EquiFrame: can provide both within and across country comparative analysis of health policies in terms of Core Concepts of human rights and inclusion of Vulnerable Groups
Disability Policy
Policies VG% CC% % of CC quality between 3 to 4
Overall Quality
Namibia National Policy on Disability
58% 95% 43% Moderate
South Africa the National Rehabilitation Policy
41% 47% 19% Low
Malawi National Policy On Equalisation Of Opportunities For Persons With Disabilities
17% 57% 67% Moderate
Sudan National Disability policy
42% 62% 24% Low
EquiFrame Findings
51 policies analyzed across Namibia, Sudan, South Africa & Malawi:
oMost frequently mentioned Vulnerable Groups across Disability, TB, HIV/AIDS policies: Disabled persons, Suffering from chronic illness, and Youth internal validity of EquiFrame methodology
oAll Core Concepts mentioned in at least one policy analyzed across project countries construct validity of categories used
o4 countries had policies scored High, Moderate and Low; each country differed in proportion of policies falling in each range
oSome very strong policies, serious shortcomings in others & country-specific patterns
oHealth sectors of each of these states face significant challenges in addressing inequities found to be present within a number of current African health policies
Project EquitAble Strategic Impact
o Provide better understanding of universal access to health care and provide an invaluable resource for health systems and policy decision makers working to meet universal access to health care, by setting out clear evidence base for proposed actions
o First known study to address this wide a range of vulnerability factors within a single data-gathering model
Measuring disability in context of other vulnerability factors may assist in disability mainstreaming in public health planning/delivery, and in appreciating that disability frequently interacts with other marginalizing factors to doubly disadvantage people with activity limitations
o Collect data from contexts where we have little information Useful for health care systems and disability sectors in Africa & EU aid
programmes for developing countries
Extensive gap in access to health care between disparate groups in low as well as high-income countries well established
Equity in health care is an astute and feasible political aspiration
If human rights and social inclusion do not underpin policy formation, it is unlikely that they will be inculcated in service delivery
Through its discernment of policy commitment to human rights and vulnerable groups, EquiFrame, devised under Project EquitAble, stands to promote the United Nations directive of ‘health for all’, with its implicit assumption of universal and equitable access to health care.
There is nothing more unequal than the
equal treatment of unequal people
Thomas Jefferson
Sources
Project website: www.equitableproject.org
Manual: Freely downloadable peer reviewed EquiFrame manual, available on project website
Papers currently in press:Amin et al. (2011). EquiFrame: a framework for analysis of the inclusion of human rights and vulnerable groups in health policies. Health & Human Rights (in press).
Mannan et al. (2011). Core Concepts of humanrights and inclusion of vulnerable groups in thedisability and rehabilitation policies of Malawi, Namibia, Sudan and South Africa. Journal of Disability Policy Studies (in press).