How do you know which health interventions are effectively reaching the poor? A conversation on equity in service-use

This blog was originally posted on the Health Systems Hub. We have cross-posted it here with permission.

How do you know which health interventions are effectively reaching the poor, especially in a world where many programs lack adequate data on the communities they serve and many others are unsure how the data they do have can be used to better target their services to those most in need?

To answer the question above, the University of California at San Francisco’s (UCSF) Global Health Group, Health Systems Hub, and the Center for Health Market Innovations (CHMI), invited a global audience of public health program managers, researchers, and practitioners to engage in a robust and open webinar discussion on equity measurement in action.

Data to measure distributions of wealth within countries has rapidly improved in the past five years, said Dominic Montagu, a social franchising for health expert who leads the Private Sector Healthcare Initiative at UCSF Global Health Group. As a result, donors and development partners are very keen to include equity measurement as a critical component of public health interventions (i.e. the World Bank announced an explicit goal to target the bottom 40 percent income quintiles)—but few tools exist for programs to put that data into action.

Groups like the African Health Markets for Equity Partnership (AHME),Heartfile Health Financing, and Marie Stopes International – Madagascar, however, have explored putting that data into action. And to speak to these experiences, the webinar featured three health specialists representing each of the groups above.

Anis Kazi, a Senior Manager at Heartfile Health Financing, discussed Heartfile’s automated health financing instrument, which can be accessed by health workers in Pakistan to seek urgent financial support for patients who run the risk of catastrophic spending. The experience, thus far, has been both a blessing and a curse. Although the program hasn’t experienced many cases of patients attempting to exploit the system, the reality is that the majority of patients who hear about the system are actually in great need, with over 40 percent of Pakistan’s population considered poor.

Matt Boxshall, Director of AHME, added that in Ghana, which has a robust national health insurance program for the African context, the politics of poverty assessment are complex, with a dual need to both incentivize the poor to participate in NHIS and dis-incentivize rent seeking behavior.

He also noted that “targeting providers who are reaching the poor means going small and going local.” In pursuit of universal health coverage, many social franchises are beginning to focus on smaller providers and providing primary care services in order to expand their reach.

Reaching the poor is expensive, and sustainability is key, mentioned Research Officer at MSI – Madagascar, James Wumenu. Currently MSI – Madagascar provides free vouchers to the poorest and most marginalized populations. However, “we cannot distribute free vouchers forever,” said Wumenu, who urged the global community to develop more cost-effective solutions. In Madagascar, there is no national health insurance scheme, but Wumenu aims to use the MSI voucher program as a successful pilot to advocate for increased financing from the national government.

Miss the webinar, or want to learn more? Visit the Health Systems Hub and watch the recorded session by clicking here. To join the discussion on equity data and learn about future webinars, make sure to sign up for the Health Systems Hub and join the webinar series discussion group.