PS014 - Research to Support Development of Equitable Health Systems

Donors, policy makers and people in general all care about equity according to Adnan Hyder (John Hopkins Bloomberg School of Public Health, USA), but more research is required to find the evidence. In a changing landscape, donors do not know if they are investing properly and policy makers lack empirical information. It is important to ask how more action on equity can be stimulated, given the fact that pro-poor health policies have proved difficult to implement, and equity promoting interventions often benefit the well off. Furthermore, what are the equity issues during a scale-up of a health intervention and how can equity be measured for health status, trust and accountability?

According to Göran Tomson (International Health Systems Research, Department of Public Health Sciences, Karolinska Institute, Sweden), "public health systems have been neglected in many countries", but, at the same time, "the private sector has been allowed to grow exponentially and without any regulation". This raises concerns about access to health care for the poor taking into consideration affordability, availability and acceptability. There has been little research done in this field although some studies do show that while the burden of disease is highest among the poor, health programmes often benefit the richest quintile in society. 

While most research is conducted in the clinical field on drugs and vaccines, little research has investigated the effects of primary health care, community capacity, health policy and social determinants of health. Thelma Narayan (Centre for Health and Equity, Community Health Cell, India) calls for more research to be conducted which also involves important stakeholders such as health workers, elected representatives and socially excluded groups while stressing the importance of accountability.

The following are some of the questions and important points which were raised during the discussion:

• The poorest of the poor have no voice and their needs are often ignored. Do Health systems and especially Public Private Partnerships reach this group?
• Health systems will not solve poverty. This is borne out by the unprecedented movement out of poverty that is taking place in China which is attributed to fast economic activity.
• The fact that many countries lack accurate data calls into question the accuracy of the published Burden of Disease statistics. It is a fact that only 20% of the world's population live in countries where 90% of deaths and births are registered.
• It is difficult to ensure 'equity', when health budgets are very low, a case in point being district health officers in Africa who have 10USD or less per capita available to them.
• When cost effectiveness data alone are used for policy decisions, this can be dangerous as these do not take note of the distribution of the service that is being provided.
• The influence of donor money and allure of publication in prestigious journals determines the types of research which are prioritised.
• There is a lack of research on the behaviour of the pharmaceutical sector in global health initiatives. A case in point is Uganda where the budget for the delivery of anti-retroviral drugs is twice the amount for the entire Ministry of health budget.