equity focused approach equity focused approach
DESCRIPTION
GKIA80211UNICEF - Equity Focused ApproachTRANSCRIPT
Taking an equity focused approach to achieving the MDGs:approach to achieving the MDGs: right in principle; right in practice?
Unequal progress2/3 countries that have made progress inmade progress in reducing U5MR have shown worsening inequalitiesinequalities(i.e gaps between better off and worse off have increased)increased)
Indicates : delivery and financing of health andfinancing of health and nutrition services as well as demand / use of these favor the better offese a o e be e o
UNICEF Progress for Children 2010
HYPOTHESISC ti l i d h b th t it i t tl• Conventional wisdom has been that it is too costly and too difficult to go into poor, hard to reach communities; reaching better off easier to reachcommunities; reaching better off, easier to reach children has been considered more cost effective.
• Hypothesis tested : Because the needs are greatestHypothesis tested : Because the needs are greatest amongst the unreached, and new, innovative, efficient strategies and tools exist to reach them, the g ,benefits of concentrating on them could outweigh the additional costs of reaching them.
• This would mean a greater equity focus would :a) be more cost effective and b) accelerate progress towards MDG’s
R i f lit t h d d f i
Testing the Hypothesis• Review of literature: hundreds of rigorous
controlled studies on equity focused strategiesR i d ff ti l l• Reviewed effective large scale programmes
• Devised an equity-focused approach building on the literature and Alma Ata Declaration(1978)the literature and Alma Ata Declaration(1978)
• Designed an analytical framework for modelingU d t k d li i• Undertook modeling exercise - used data from 15 out of 60 countries reviewed
l d 180 000 d i- analyzed 180,000 data points- compared equity focused approach and the
t th i t f t ff ti b 2015current path in terms of cost effectiveness by 2015 and contribution to health related MDG’s
Two model strategies were compared -Current and Equity-focused approach q y pp
Modeled equity-focused approach - adds ways to ensure the most deprived children are reachedensure the most deprived children are reached
(a) Different ways of delivering services: Shifting treatment of main child killers to communitiesProviding maternal and newborn services closer to communitiesIncentives for improved distribution and performance of health workers
(b) Reducing financial barriers for the poor(b) Reducing financial barriers for the poorReducing costs of drugs and other commoditiesInsurance or free provision of services for the poorSubsidizing indirect costs for using services e.g. through cash transfersSubsidizing indirect costs for using services e.g. through cash transfers
(c) Empowering communities Community participation and organizationC it b d ti f iti h lth l t d tiCommunity based promotion of positive health-related practicesIntensified communication e.g face to face
Cost effective proven interventions are known p- strategies differ in the way these are
delivered, promoted and financed
Child 2003
Nutrition series
Maternal
Child develop
ment series 2007
Newborn 2005
2003 series 2008
Series2006
Repro-ductive Health
2007
Series2006
E it T l A Equity Typology B1
Distribution patterns for mortality and deprivation in 15 countries – 4 typologies
150
200
250
60%
80%
100%
lity
per 1
,00
hsrage
Def
icit
Equity Typology A
6080 100 120 140
60%
80%
100%
ality
per
1,0
0 hse
Def
icit
Equity Typology B1
-
50
100
0%
20%
40%
Lowest Second Middle Fourth Highest Und
er 5
mor
tabi
rth
% C
over
-20 40 60
0%
20%
40%
Lowest Second Middle Fourth Highest Und
er 5
mor
tabi
rth
% C
over
ag
Wealth Quintiles Wealth Quintiles
70100%Equity Typology C
*Niger, Mali, Rwanda, Uganda *Benin, Kenya, Nigeria,,Zimbabwe, Ghana
Equity Typology B2
30 40 50 60 70
40%
60%
80%
100%
rtal
ity p
er 1
,00
rths
vera
ge d
efic
it4050 60 70 80 90 100
40%
60%
80%
100%rt
ality
per
1,0
0 irt
hs
erag
e de
ficit
Equity Typology B2
-10 20
0%
20%
Lowest Second Middle Fourth Highest Und
er 5
mor bi
% C
ov
-10 20 30 40
0%
20%
40%
Lowest Second Middle Fourth Highest
Und
er 5
mor bi
% C
ove
Coverage Deficit score Under five Mortality rate
Wealth Quintiles
*Philippines, Vietnam South Africa*Honduras, Bangladesh, Pakistan
Using MBB (WB-UNICEF) Supply and Demand bottlenecks for most / least deprived areas analyzed100%
p y
Supply Bottleneck
75% (esp. midwives shortage) Demand Bottleneck (esp.
50%Financial access)
25%
0%COMMODITIES: % HUMAN RES: % ACCESS: % UTILISATION: % CONTINUITY: % EFFECTIVE COV: health centres with no perinatal supply
stock-outs
facilities with sufficient workers
families living near health facility with
daily service provision
deliveries assisted by trained worker
deliveries with i) SBA ii) weighed &
iii) receive 3 postnatal care visits
% of SBA deliveries occur within a ANC-
qualified health facility
Mortality: causes in poor compared to rich children
250(Under Five Mortality Rate per 1000 Live Births)
Others
4.9
21.6 200
InjuriesAIDS
6.6
36.7
150
AIDS Pneumonia
Measles56.3
1 68.8
100
MeaslesMalariaDiarrhea
50
11
22.1 1.6
13.9 1.6
50
DiarrheaNeonatal
40.7 26.9
0Nigeria: Nigeria Q1 Nigeria: Nigeria Q5 (richest)
Analytical FrameworkCoverage
35%
30%
25%
Coverage
25%
20%
15%
10%
35 30 25 20 15 10 5 0 5% 10% 15% 20% 25% 30% 35%
10%
5%Inputs/costs Impact
10
102
103
Low
103
104
105
106
107High MDG progress
Impact on child mortality in most
100 sand least deprived areas
7080 90
live
birt
h
Baseline
4050 60 70
per 1
,000
Current
20 30 40
mor
talit
y p
Equity Focused
-10
Most Deprived Areas Least Deprived AreasUnd
er 5
mU
Progress towards MDG 4
140
160
hs
141
100
120
00 li
ve b
irth
Historical path
88
80
100
ity p
er 1
,00
Current Path
Equity
40
60
er 5
mor
tali q y
Focused
MDG Target
20 Und
e
-1990 1995 2000 2005 2010 2015
Per $1m additional invested - equity-focused strategies can avert more child deaths
120
140
Equity Typology A
100
120
Equity Typology B1
20
40
60
80
100
20
40
60
80
-
20
Current Equity Focused-
20
Current Equity Focused*Niger, Mali, Rwanda, Uganda *Benin, Kenya, Nigeria, Zimbabwe, Ghana
60 70
Equity Typology B2
25
30
Equity Typology C
10
20
30
40
50
5
10
15
20
-
Current Equity Focused
-
Current Equity Focused*Philippines, Vietnam South Africa*Honduras, Bangladesh, Pakistan
Conclusion• An equity-focused approach improves returns on
investment, averting many more child and maternal deaths d i d f t ti th th t thand episodes of stunting than the current path.
• Using an equity focused approach a US $1 million• Using an equity focused approach, a US $1 million investment in reducing under-five deaths in a low-income, high-mortality country would avert an estimated 60% more d th th th t hdeaths than the current approach.
• Because national burdens of disease ill health and• Because national burdens of disease, ill health and malnutrition are concentrated in the most excluded and deprived child populations, providing these children with essential services can accelerate progress towards the health related MDGs and reduce disparities within nations.