Equity in access to injury prevention & trauma care Olive Kobusingye, M.B.Ch.B, M.Med(Surg), MPH Makerere University School of Public Health
Equityinaccesstoinjuryprevention&traumacare
OliveKobusingye,M.B.Ch.B,M.Med(Surg),MPHMakerere UniversitySchoolofPublicHealth
Equityinaccesstoinjurypreventionandtraumacare
• Equityinhealthimpliesthatideallyeveryoneshouldhaveafairopportunitytoattaintheirfullhealthpotential…thatnooneshouldbedisadvantagedfromachievingthispotential,ifitcanbeavoided.
• Equalaccesstoavailablecareforequalneed,equalutilizationforequalneed,equalqualityofcareforall.
WhiteheadM.1990.TheConceptsandPrinciplesofEquityinHealth.Copenhagen:WHO,Reg.Off.Eur.(EUR/ICP/RPD4147734r).29pp.
Reasonswhyinterventionsarenotimplemented
• Interventionsdonotexist
• Interventionsarenotaffordable
• Interventionsarenotappropriateforthesettings– henceknowledgetransfer
• Interventionsrequiretheparticipationofmanyentitiesandwehaveyettofigureouthowtogetthemtoworktogether
Equityinaccess
toinjurypreventionandtraumacare
inLMICs
Thefallacyoflowincomes• Theinjurypreventionfieldhasmadeabigdealofincomecategories
• Incomesare important• Hasincomedisparitybetweenoverrated?• Isincomeagoodproxy?• Whatis/aretheunderlyingfactor(s),andwhyarewenotusingthem?
• Categoriestoobroadtobemeaningful?
Othercategorisations
• Poorandrichcountries
• NorthandSouth
• Developedandundeveloped/
developing
Governance
• Governance:theprovisionofthepolitical,socialandeconomicgoodsthatacitizenhastherighttoexpectfromtheirstate,andthatastatehastheresponsibilitytodelivertoitscitizens.
• Failureofgovernance:failurebythestatetoprovideanessentialgood(service,e.g.ETC),onethatispossibletoprovide,andthatcitizensarereasonabletoexpect
IbrahimIndexofAfricanGovernance
IbrahimIndexofAfricanGovernance
4• categories
14• sub-categories
93• indicators
• Updatedeveryyear
• 54countries
• 33differentdata
institutions
IbrahimIndexofAfricanGovernance
TheSafety&RuleofLaw:
• theextenttowhichallindividualsareprotectedfrombothinternalandexternalthreatstothepeace.
• Thedegreetowhichsocietyissafeandsecureisassessedalongsidetheexistenceofarobustlegalsystem andtransparent,effectiveandaccessibleinstitutions,withinallbranchesofthestate.
IbrahimIndexofAfricanGovernance
Accountability
• Transparency&CorruptioninthePublicSector
• Accesstoinformation• Bureaucracy• CorruptioninGovernment&PublicOfficials• DiversionofPublicFunds• AccountabilityofPublicOfficials• PublicSectorCorruptionInvestigation• ProsecutionofAbuseofOffice
Amuchsimplerindex(OK)
ByDanielKaufmann,Aart Kray andMassimoMastruzzi - WorldwideGovernanceIndicators,PublicDomain,https://en.wikipedia.org/w/index.php?curid=23861869
Lackofaccountability
ByDanielKaufmann,Aart Kray andMassimoMastruzzi - WorldwideGovernanceIndicators,PublicDomain,https://en.wikipedia.org/w/index.php?curid=23861869
AreLMICsdifferentfromLMACs?
• Thesamecountriesmayfeatureinboth
• Thelowaccountabilityprobablyexplainsthelowincomesmorethanthereverse
• Threecategories(equitableaccess):– UnablebutWilling/Caring
– UnableandUncaring– AblebutUncaring
EXAMPLES
LakeVictoria
LifeLinesonLakeVictoria
• 2nd largestlakeintheworld,3,700kmofcoastline,200inhabitedislands,200,000fishermenand700tonesoffishannually,worthUS$400million.
• Estimated5,000drownings annually• 2008- 2010apartnershipofGSMADev Fund,Zain,Ericsson,NationalLakeRescueInstituteandtheKalangala Fishingcommunitypilotedawatersafetyproject
Projectcomponents
• Search&Rescueinfrastructureandpersonnel
• Communication(MaritimeRescueCordCtr)
• Lifejackets– manufacture&distribution
• Localcommunitiesmobilized&engaged
Improvedlakesafety2012
• Partnership:WMO,Ericsson,MTN,UgandaDepartmentofMeteorology,andNationalLakeRescueInstituteintroducedMobileWeatherForecasting forfishingcommunitiesonlakeVictoria…
toenablethemto“makeaninformeddecisionastowhethertheytravel,tradeorfishontheLake”
Accesstopost-crashcare
Country GNI Vitalreg%transportedinambulance IIAG
Angola 5170 No <11 40Benin 790 Yes 11to49 58Botswana 7770 Yes 11to49 78Cameroon 1290 Yes <11 45DRCongo 430 No <11 33Egypt 3140 Yes <11 51Ghana 1770 Yes 11to49 67Libya 12930 Yes <11 35Malawi 270 Yes Noamb service 57Mauritius 9290 Yes 75plus 80
Mozambique 610 Yes Noamb service 52
Accesstopost-crashcare
Country GNI Vitalreg%transportedinambulance IIAG
Angola 5170 No <11 40Benin 790 Yes 11to49 58Botswana 7770 Yes 11to49 78Cameroon 1290 Yes <11 45DRCongo 430 No <11 33Egypt 3140 Yes <11 51Ghana 1770 Yes 11to49 67Libya 12930 Yes <11 35Malawi 270 Yes Noamb service 57Mauritius 9290 Yes 75plus 80
Mozambique 610 Yes Noamb service 52
Whatthen?
• Incomesarenotnecessarilythe(main)ormostrelevantcategorizingfactor
• Shiftdiscoursetoaccountability
• Findwaysinwhichtoassess&communicateaccountabilityinourresearch
• Advocateinwaysthatincreaseaccountability
• Explorehowtoavoidthesustainabilitytrap
A poor man who is unhappy is better off than a rich man who is unhappy.
The poor man still has hope.
He thinks money would help.