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Research to action to address inequities: the experience of the Cape Town Equity Gauge.

Scott V, Stern R, Sanders D, Reagon G, Mathews V - Int J Equity Health (2008)

Bottom Line: The development of a community Water and Sanitation Forum to support the Project had some notable successes, but also experienced some difficulties due to lack of capacity in both the community and the municipality.The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages.The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, University of Western Cape, South Africa. rstern@uwc.ac.za.

ABSTRACT

Background: While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description that follows looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem.We give an overview of the first phase of our research in which we did an initial assessment of health status and the socio-economic determinants of health across the subdistrict health structures of Cape Town. We then describe two projects from the second phase of our research in which we move from research to action. The first project, the Equity Tools for Managers Project, engages with health managers to develop two tools to address inequity: an Equity Measurement Tool which quantifies inequity in health service provision in financial terms, and a Equity Resource Allocation Tool which advocates for and guides action to rectify inequity in health service provision. The second project, the Water and Sanitation Project, engages with community structures and other sectors to address the problem of diarrhoea in one of the poorest areas in Cape Town through the establishment of a community forum and a pilot study into the acceptability of dry sanitation toilets.

Methods: A participatory approach was adopted. Both quantitative and qualitative methods were used. The first phase, the collection of measurements across the health subdistricts of Cape Town, used quantitative secondary data to demonstrate the inequities. In the Equity Tools for Managers Project further quantitative work was done, supplemented by qualitative policy analysis to study the constraints to implementing equity. The Water and Sanitation Project was primarily qualitative, using in-depth interviews and focus group discussions. These were used to gain an understanding of the impact of the inequities, in this instance, inadequate sanitation provision.

Results: The studies both demonstrate the value of adopting the GEGA approach of research to action, adopting three pillars of assessment and monitoring; advocacy; and community empowerment. In the Equity Tools for Managers Project study, the participation of managers meant that their support for implementation was increased, although the failure to include nurses and communities in the study was noted as a limitation. The development of a community Water and Sanitation Forum to support the Project had some notable successes, but also experienced some difficulties due to lack of capacity in both the community and the municipality.

Conclusion: The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.

No MeSH data available.


Related in: MedlinePlus

Selection criteria for indicators of health need in the Cape Town context. This is a list of criteria that health managers in Cape Town felt should be applied when selecting indicators of health need to be used in the Cape Town context.
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Figure 1: Selection criteria for indicators of health need in the Cape Town context. This is a list of criteria that health managers in Cape Town felt should be applied when selecting indicators of health need to be used in the Cape Town context.

Mentions: The subdistrict managers were identified as key to implementation of equity actions, as they have direct responsibility for operationalising policy within the primary level services. They requested assistance in quantifying the inequity in a manner that would enable them to use the control they had over public primary health expenditure. The series of workshops continued. A technical support team was established with specialists invited to participate on the basis of their skills (in public health, health information systems, public sector financing, health policy and planning and health economics) and their familiarity with the Cape Town context. The role of the technical team was limited to specialist advice and the final decision-making power remained with the subdistrict managers. An Equity Measurement Tool was developed to quantify health need in each of the health subdistricts. The technical aspects of this tool are described in detail in a Cape Town Equity Gauge report [21]. Through the process of debate subdistrict managers set criteria for indicators of health need in the Cape Town context. These are shown in Figure 1. They also decided to weight the various indicators of need to create a composite measure of "need for primary level health services". This was then compared with public primary level health expenditure in each health subdistrict. The mismatch between the need for primary level health services and public primary level health expenditure, [as shown in Additional file 7], was dramatic, serving as a powerful source of advocacy. In the Additional file 7, the zero line represents equitable public primary level health expenditure. A bar above the line represents public primary level health expenditure in excess of what is equitable and a bar below the line indicates an expenditure deficit.


Research to action to address inequities: the experience of the Cape Town Equity Gauge.

Scott V, Stern R, Sanders D, Reagon G, Mathews V - Int J Equity Health (2008)

Selection criteria for indicators of health need in the Cape Town context. This is a list of criteria that health managers in Cape Town felt should be applied when selecting indicators of health need to be used in the Cape Town context.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2275279&req=5

Figure 1: Selection criteria for indicators of health need in the Cape Town context. This is a list of criteria that health managers in Cape Town felt should be applied when selecting indicators of health need to be used in the Cape Town context.
Mentions: The subdistrict managers were identified as key to implementation of equity actions, as they have direct responsibility for operationalising policy within the primary level services. They requested assistance in quantifying the inequity in a manner that would enable them to use the control they had over public primary health expenditure. The series of workshops continued. A technical support team was established with specialists invited to participate on the basis of their skills (in public health, health information systems, public sector financing, health policy and planning and health economics) and their familiarity with the Cape Town context. The role of the technical team was limited to specialist advice and the final decision-making power remained with the subdistrict managers. An Equity Measurement Tool was developed to quantify health need in each of the health subdistricts. The technical aspects of this tool are described in detail in a Cape Town Equity Gauge report [21]. Through the process of debate subdistrict managers set criteria for indicators of health need in the Cape Town context. These are shown in Figure 1. They also decided to weight the various indicators of need to create a composite measure of "need for primary level health services". This was then compared with public primary level health expenditure in each health subdistrict. The mismatch between the need for primary level health services and public primary level health expenditure, [as shown in Additional file 7], was dramatic, serving as a powerful source of advocacy. In the Additional file 7, the zero line represents equitable public primary level health expenditure. A bar above the line represents public primary level health expenditure in excess of what is equitable and a bar below the line indicates an expenditure deficit.

Bottom Line: The development of a community Water and Sanitation Forum to support the Project had some notable successes, but also experienced some difficulties due to lack of capacity in both the community and the municipality.The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages.The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, University of Western Cape, South Africa. rstern@uwc.ac.za.

ABSTRACT

Background: While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description that follows looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem.We give an overview of the first phase of our research in which we did an initial assessment of health status and the socio-economic determinants of health across the subdistrict health structures of Cape Town. We then describe two projects from the second phase of our research in which we move from research to action. The first project, the Equity Tools for Managers Project, engages with health managers to develop two tools to address inequity: an Equity Measurement Tool which quantifies inequity in health service provision in financial terms, and a Equity Resource Allocation Tool which advocates for and guides action to rectify inequity in health service provision. The second project, the Water and Sanitation Project, engages with community structures and other sectors to address the problem of diarrhoea in one of the poorest areas in Cape Town through the establishment of a community forum and a pilot study into the acceptability of dry sanitation toilets.

Methods: A participatory approach was adopted. Both quantitative and qualitative methods were used. The first phase, the collection of measurements across the health subdistricts of Cape Town, used quantitative secondary data to demonstrate the inequities. In the Equity Tools for Managers Project further quantitative work was done, supplemented by qualitative policy analysis to study the constraints to implementing equity. The Water and Sanitation Project was primarily qualitative, using in-depth interviews and focus group discussions. These were used to gain an understanding of the impact of the inequities, in this instance, inadequate sanitation provision.

Results: The studies both demonstrate the value of adopting the GEGA approach of research to action, adopting three pillars of assessment and monitoring; advocacy; and community empowerment. In the Equity Tools for Managers Project study, the participation of managers meant that their support for implementation was increased, although the failure to include nurses and communities in the study was noted as a limitation. The development of a community Water and Sanitation Forum to support the Project had some notable successes, but also experienced some difficulties due to lack of capacity in both the community and the municipality.

Conclusion: The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.

No MeSH data available.


Related in: MedlinePlus