Experts Call for Greater Political Will and a Focus on Systems to Scale-Up Health Equity
April 17, 2018
Health inequity derives from a complex set of factors and requires a set of integrated, systemic responses. This was a key message coming out of a policy forum hosted by the Health Policy Plus (HP+) project on April 17, 2018, entitled "Targeting Health Inequity: Smart Moves with New Tools and Approaches." The forum featured Ellen Starbird of USAID, Joe Kutzin and Veronica Magar of the World Health Organization (WHO), and HP+ speaker Suneeta Sharma and moderator Arin Dutta, who together explored the causes of health inequity, the pros and cons of national health insurance programs with respect to impacts on health equity, and new tools and approaches to reach universal health coverage and reduce health inequity.
"We need to find a way to make health financing more boring and service delivery more interesting."
– Joe Kutzin
Ellen Starbird, Director of the Office of Population and Reproductive Health at USAID, introduced the topic of equity by telling the story of Fatima, a Bangladeshi mother who did not seek prenatal health services for her first pregnancy and gave birth at home to a stillborn child. When Fatima conceived her second child, after discovering the existence of a clinic that offered free maternal health services, she sought care at the clinic and gave birth to a healthy baby with the assistance of skilled providers. Following the birth, Fatima was counseled on healthy behaviors and infant care. This story, Ms. Starbird explained, exemplifies the value of providing equitable, quality health services to all. "Equity means being able to successfully reach those people who are otherwise marginalized, less able than others to access services when they need them," she said. This is essential, she explained, to affect real change.
HP+ Project Director Suneeta Sharma echoed this sentiment, focusing on two countries—Indonesia and Kenya—to discuss inequity in healthcare and emphasize the importance of political will in designing health sector reforms that improve access and are enduring. "By political commitment, it's not just that it's very important for us to achieve health equity goals, make services available to the poor and be fair in what we are doing," she explained. "It's more about allocating resources, setting up financing mechanisms, and also monitoring progress. See how we are making a difference. And continue to look at the information and make changes to achieve the goals we are all committed to trying to achieve."
"Schemes are good, systems are better."
– Arin Dutta
Two guest speakers from the WHO, Coordinator of Health Financing Joseph Kutzin and Veronica Magar, Team Leader for Gender, Equity, and Human Rights, then addressed the forum. Mr. Kutzin discussed the importance of using a systems approach to improve access and financial protection for the poor. "The 'we can focus on the poor or focus on universal healthcare' mindset" is a false dichotomy, he explained. "Because 'we are focused on the poor' doesn't mean we can forget the rest of the system." Kutzin explained that a sole focus on health financing reforms in the past may have made things worse. "We need to find a way to make health financing more boring and service delivery more interesting," he said, stressing the need to consider demand-side issues such as barriers faced by those trying to obtain services.
Dr. Magar followed by presenting an overview of the WHO's present systematic approaches and new tools in health equity analyses that not only produce evidence but also generate action-oriented use of evidence to support countries to strengthen programs, policies, and systems that ensure no one is left behind.
The panel of speakers was followed by a lively discussion, moderated by HP+'s Senior Technical Director of Health Financing, Arin Dutta, who summarized the discussion theme as "schemes are good, systems are better." The discussion explored the importance of political capital to make pro-poor policies work and strategies for middle income countries to protect health access gains for the poor at a time when donor resources are declining. Ellen Starbird, reminding the audience that family planning has a direct impact on a nation's health resource needs, also emphasized that countries should be considering primary health coverage now in an effort to move toward equitable access for all. Stephen Muchiri and Mariana Balampama, HP+ Country Directors who were present for the session, shared additional measures being explored at the county level in Kenya and at national and local levels in Tanzania, including building on existing community-based models and efforts to reach those working in the informal sector.