Public Health and Health Systems

Making people count

If the rich consume more health resources than the poor, any efforts to redress the gap between the haves and have-nots must include a commitment to equity and not just equality. Sue Valentine attended a recent international workshop in the North West Province aimed at developing efective equity gauges to measure the gaps in health spending and resource allocation.

It has long been understood among health economists that the rich consume more public health care than the poor, and that immunisation coverage correlates strongly with socio-economic status.

A workshop organised by the Health Systems Trust (HST) recently brought together health researchers, legislators and economists from 16 different countries to look at the best means of measuring the gaps between rich and poor in the delivery of health services with a view to ensuring a fairer distribution of resources.

The aim of the four-day gathering was for different countries to present their proposals for health equity gauges and to analyse and strategise the best ways of ensuring that equity is incorporated into government planning and understood by communities.

Health workers from Chile, China, Bangladesh, the Philippines, Uganda, Zambia, Zimbabwe, Ethiopia and South Africa were among those who attended.

Health equity, essentially, is about ensuring a “fair share” of resources. It goes further than equality, because it takes into account the need to redress the gap between the rich and poor and to ensure a fair distribution within any given society.

Chairperson of the HST, Francie Lund warned that inequities in health care provision in South Africa would most likely be exacerbated by the impact of HIV/AIDS. In addition, the transfer of primary health care from provincial to local government later this year was also likely to have a negative impact.

In his address to the meeting, chairperson of the parliamentary health portfolio committee, Abe Nkomo, stressed the importance of an inter-sectoral approach to ensure affordable and accessible health care.

In some cases, the deterioration of access roads to hospitals was as much of a problem as the state of the hospital, Nkomo said. “Technically this may be a transport issues, but actually it’€™s a health care issue.”

He said the compartmentalised approach by governments was often part of the problem. “An inter-sectoral approach must cut across boundaries ‘€“ regionally and globally.”

Tim Evans of the Rockefeller Foundation, one of the sponsors of the workshop, said that by 2015, the vision was for every country to have an integrated system to monitor health.

“We must make people count,” he said. This should be done by measuring and monitoring health delivery, by regular reporting of inequities and by setting equity targets that identified what worked best in order to overcome the gap between rich and poor.

The deputy finance minister, Mandisi Mpahlwa, made a brief visit to the workshop and assured delegates of governent’€™s commitment to equity. He re-emphasised the importance of monitoring the equity gap and holding government to account.

South Africa already has a national equity gauge in place. It is driven jointly by the Health Systems Trust and four national parliamentary portfolio commttees and three provincial committees.

A local level equity gauge to measure inequities within and between different communities in Cape Town is still in the development stages and will be launched soon. ‘€“ Health-e News Service

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