About Us » Newsroom » Equity in Health: November 13, 2009
Pro-Poor Approaches Lead the Way to Equity in Health
Overall improvements in healthcare systems and delivery often fail to benefit those in greatest need. In many countries the poor represent the largest population group but have worse health outcomes, use health services less, and benefit less from government health expenditures than the economically better-off. They may be dispersed widely over rural areas or concentrated in urban slums, impeding access to all types of services. They have less ability to advocate for themselves and to engage others on their behalf.
The links between poverty reduction and reproductive health (RH) issues are well known. Satisfying unmet need for family planning (FP) can reduce the number of births, thus slowing population growth and reducing the strain on scarce national- and household-level resources. Over time the cost savings can be applied more efficiently to other societal needs. Improving maternal health has a ripple effect on families. Healthy mothers are better able to contribute to their children’s health and education as well as to household resources. The HIV epidemic is reversing national development gains in heavily-affected countries and bankrupting families and whole communities through lost wages and high medical costs—highlighting the need to expand access to prevention, treatment, and care, especially for underserved groups.
As the implementer of Task Order 1 of the USAID | Health Policy Initiative, Futures Group has designed a Poverty-Equity Framework for formulating policy responses that help ensure that FP/RH, HIV, and maternal health services reach the poor. A policy response includes not only policies, strategic plans, and operational guidelines; it also encompasses the resources, evidence base, and multisectoral coordination and leadership needed to develop and implement pro-poor programs.
The Poverty-Equity Framework includes the following five key components:
- Adopting and implementing policies that improve equitable and affordable access to healthcare services;
- Strengthening political commitment and promoting leadership and capacity development among the poor;
- Mobilizing resources and ensuring they are allocated effectively and equitably;
- Strengthening multi-sectoral engagement; and
- Encouraging evidence-based decision making to support pro-poor policies.
The international development community is placing greater emphasis on the goals of poverty reduction and achieving equity. The increasing prominence of poverty reduction as an overarching goal represents a gradual move to a broader development approach from an earlier approach focused on investments in economic growth. The Millennium Development Goals (MDGs) set by the international community in 2000 embrace this shift.
The first MDG is to eradicate extreme poverty, with the specific objective of reducing by half, between 1990 and 2015, the proportion of people in developing countries living on an income of less than $1 a day.1 According to an analysis of trends between 1990 and 2001, Asia has achieved significant progress toward this goal.2 Other regions, most notably sub-Saharan Africa, have experienced an increase in the share of their populations living in extreme poverty. There is also evidence that the poor are becoming even poorer.
The Futures Group has applied these principles in numerous countries, including Guatemala, India, Kenya, Nepal, Nigeria, Peru, South Africa, Tanzania, and Uganda. Following are examples of work in three countries.
- Peru: Disparities in access to health services among income groups, regions, and ethnic groups are found in family planning (FP) use as well. To help address this gap, beginning in 2006, the Health Policy Initiative worked with in-country partners to design and test strategies to meet the FP/RH needs of poor women in Peru’s Junín Region. The project devised a two-step process to (1) identify and understand barriers that affect poor women’s access to and use of FP services; and (2) incorporate appropriate interventions into existing programs to ensure a sustainable and replicable response.
- India: In India, USAID is providing financial and technical support to develop public-private partnerships to expand access to FP/RH and child health services among the poor. As part of this work, the USAID-funded Innovations in Family Planning Services Technical Assistance Project (ITAP/Delhi), implemented by Futures Group, developed a model for a voucher scheme to enable women below the poverty line (BPL) to use FP/RH and child health services offered by collaborating private providers. This model was pilot-tested in Agra District, Uttar Pradesh, and was adopted by the state government in 2008 as part of a new initiative to improve maternal health.
- Mali: Futures Group designed a guide to help family planning champions—including civil society and NGOs, international and donor organizations, and interested government officials—and other stakeholders promote the inclusion of family planning issues and programs into Poverty Reduction Strategy Papers (PRSPs). Countries prepare PRSPs to qualify for loans and debt relief from the World Bank and International Monetary Fund. As a condition of receiving assistance, the PRSPs must outline the macroeconomic and social policies countries will adopt to alleviate poverty and, ultimately, accelerate progress toward meeting the MDGs.
For more information regarding Futures’ work in this area, please see our publications listed below:
Achieving the MDGs: The Contribution of Family Planning in Nepal
Approaches That Work: Health Equity in Peru
Increasing Access to Family Planning Among the Poor in Peru: Building on and Strengthening Financing Mechanisms for the Poor
A Multi-tiered Approach to Meeting Family Planning Needs of the Poor in Peru
Increasing Access to Family Planning Among Indigenous Group
Increasing Access to Family Planning Services Among Indigenous Groups in Guatemala
For more information on Futures Group’s Equity in Health Approach, contact Farley Cleghorn at fcleghorn@futuresgroup.com or Suneeta Sharma at ssharma@futuresgroup.com.
Millennium Development Goals Report. United Nations. 2006. New York: United Nations
Millennium Development Goals Report. United Nations. 2005. New York: United Nations