National health inequality monitoring: current challenges and opportunities

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne; Boerma, Ties

doi:10.1080/16549716.2017.1392216

Cited by 42 publications

(53 citation statements)

References 15 publications

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“…Our findings make visible, and quantify, the large wealth and urban/rural inequities which most countries, even those that have improved birth registration, must tackle. These findings contribute to: critical scholarship on who is excluded from definitions and counts of a population59; the growing literature on the importance of studying changes in health inequities over time60–63 and to research arguing for the importance of public health data systems which allow health equity to be monitored to guide the development of equity-oriented policies, programme and practices 46 64–66. More specifically, our findings support current research and policy calling attention to the need to improve CRVS systems which remain underfunded, underprioritised and underdeveloped in many countries,3–5 have made modest progress,5 21 and continue to exclude marginalised populations 11.…”

Section: Discussionsupporting

confidence: 69%

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

et al. 2019

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IntroductionAlthough global birth registration coverage has improved from 58% to 71% among children under five globally, inequities in birth registration coverage by wealth, urban/rural location, maternal education and access to a health facility persist. Few studies examine whether inequities in birth registration in low-income and middle-income countries have changed over time.MethodsWe combined information on caregiver reported birth registration of 1.6 million children in 173 publicly available, nationally representative Demographic Health Surveys and Multiple Indicator Cluster Surveys across 67 low-income and middle-income countries between 1999 and 2016. For each survey, we calculated point estimates and 95% CIs for the percentage of children under 5 years without birth registration on average and stratified by sex, urban/rural location and wealth. For each sociodemographic variable, we estimated absolute measures of inequality. We then examined changes in non-registration and inequities between surveys, and annually.Results14 out of 67 countries had achieved complete birth registration. Among the remaining 53 countries, 39 countries successfully decreased the percentage of children without birth registration. However, this reduction occurred alongside statistically significant increases in wealth inequities in 9 countries and statistically significant decreases in 10 countries. At the most recent survey, the percentage of children without birth registration was greater than 50% in 16 out of 67 countries.ConclusionAlthough birth registration improved on average, progress in reducing wealth inequities has been limited. Findings highlight the importance of monitoring changes in inequities to improve birth registration, to monitor Sustainable Development Goal 16.9 and to strengthen Civil Registration and Vital Statistics systems.

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Section: Discussionsupporting

confidence: 69%

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

et al. 2019

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“…The conceptualization of health may focus on assessments of health status, well-being or functioning [23,24]; it may also capture any other aspect of the health system (including health governance, health financing, health services access and readiness, and health service coverage) [2,25], determinants of health, or health-related norms, values, behaviours and attitudes [26]. The distribution of health construct addresses the comparison of health across subgroups, including the question of how subgroups of individuals are defined [27,28]. The third construct addresses whether a specified aspect of health and its distribution is problematic from a moral/ethical perspective.…”

Section: Theorized Constructs Of Health Equitymentioning

confidence: 99%

Subnational health management and the advancement of health equity: a case study of Ethiopia

Bergen

Rückert

Kulkarni

et al. 2019

glob health res policy

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Background: Health equity is a cross-cutting theme in the United Nations 2030 Agenda for Sustainable Development, and a priority in health sector planning in countries including Ethiopia. Subnational health managers in Ethiopia are uniquely positioned to advance health equity, given the coordination, planning, budgetary, and administration tasks that they are assigned. Yet, the nature of efforts to advance health equity by subnational levels of the health sector is poorly understood and rarely researched. This study assesses how subnational health managers in Ethiopia understand health equity issues and their role in promoting health equity and offers insight into how these roles can be harnessed to advance health equity. Methods: A descriptive case study assessed perspectives and experiences of health equity among subnational health managers at regional, zonal, district and Primary Health Care Unit administrative levels. Twelve in-depth interviews were conducted with directors, vice-directors, coordinators and technical experts. Data were analyzed using thematic analysis. Results: Subnational managers perceived geographical factors as a predominant concern in health service delivery inequities, especially when they intersected with poor infrastructure, patriarchal gender norms, unequal support from non-governmental organizations or challenging topography. Participants used ad hoc, context-specific strategies (such as resource-pooling with other sectors or groups and shaming-as-motivation) to improve health service delivery to remote populations and strengthen health system operations. Collaboration with other groups facilitated cost sharing and access to resources; however, the opportunities afforded by these collaborations, were not realized equally in all areas. Subnational health managers' efforts in promoting health equity are affected by inadequate resource availability, which restricts their ability to enact long-term and sustainable solutions. Conclusions: Advancing health equity in Ethiopia requires: extra support to communities in hard-to-reach areas; addressing patriarchal norms; and strategic aligning of the subnational health system with non-health government sectors, community groups, and non-governmental organizations. The findings call attention to the unrealized potential of effectively coordinating governance actors and processes to better align national priorities and resources with subnational governance actions to achieve health equity, and offer potentially useful knowledge for subnational health system administrators working in conditions similar to those in our Ethiopian case study.

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“…Health data disaggregation helps governments identify the health state of the disadvantaged groups [20]. The data requires to be monitored and acted upon for addressing the root causes of inequalities through appropriate policy and programme development [21].…”

Section: Health Inequality Monitoringmentioning

confidence: 99%

Tools and approaches to operationalize the commitment to equity, gender and human rights: towards leaving no one behind in the Sustainable Development Goals

Zamora

Koller

Thomas

et al. 2018

Global Health Action

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The objective of this article is to present specific resources developed by the World Health Organization on equity, gender and human rights in order to support Member States in operationalizing their commitment to leave no one behind in the health Sustainable Development Goals (SDGs), and other health-related goals and targets. The resources cover: (i) health inequality monitoring; (ii) barrier analysis using mixed methods; (iii) human rights monitoring; (iv) leaving no one behind in national and subnational health sector planning; and (v) equity, gender and human rights in national health programme reviews. Examples of the application of the tools in a range of country contexts are provided for each resource.

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National health inequality monitoring: current challenges and opportunities

Cited by 42 publications

References 15 publications

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

Subnational health management and the advancement of health equity: a case study of Ethiopia

Tools and approaches to operationalize the commitment to equity, gender and human rights: towards leaving no one behind in the Sustainable Development Goals

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