PROF. MALCOLM MACLACHLAN EQUITABLE PROJECT MANAGER [email protected] DR. HASHEEM MANNAN EQUITABLE SENIOR RESEARCH FELLOW [email protected].

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

Vulnerable Groups

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

Summary Indices

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).