Through a series of presentations and plenary and small group discussions,
participants sought to better understand:
- factors affecting the attainability and affordability of equity
- strategies to promote equity in health care provision
- the trade-offs which may be necessary in the implementation of strategies
- positive spin-offs and unintended consequences of different strategies
- ways of monitoring progress towards equity in health care provision.
Affordability and attainability of equity in health care
Economics professor Bill Hsiao presented his view of the attainability and
affordability of equity in health care provision, outlining a number of
prerequisites for achieving greater equity. Noting the tendency of leaders to
focus on financing strategies, he stressed that human resource development,
management capacity and information systems were equally important factors in
the attainment of equity. Are equal health services affordable? By definition,
argues Hsiao, yes - if expenditure equals revenue. But adequate revenue
generation and its allocation and use require leadership, political will and
savvy. In turn, these requirements depend on public support and satisfaction
with the quality of service provision.
Strategies toward greater equity in health care provision
Gerald Bloom argued that the first step for governments was to recognise
their inability to ensure equal access to all health services, so that they can
concentrate on measures that yield the greatest benefits.
Restructuring of the health sector was the first major task toward equity, which
entailed: placing equity at the centre of strategic plans setting clear
objectives for improving access to basic health services formulating strategies
for best use of available resources and monitoring progress. In addition, Bloom
considered options for financing increases in the funding of basic health
services once the size of the public health budget has been determined.
Continuing the theme of health sector restructuring as a critical strategy
towards equity, provincial governor Rosario Diaz outlined the process of
decentralisation of public health administration in the Philippines. The
experience of the Cotabato province illustrated that governance, service
integration and equity can be enhanced through devolution.
South African efforts to achieve greater equity in health care provision were
reviewed and assessed. In background papers to the Seminar, Diane McIntyre spelt
out the dimensions of inequity in South Africa, while David Harrison summarised
health care developments since 1994. Peter Barron provided a critical appraisal
of some of the main strategies towards equity adopted by the Ministry of Health.
Emmanuelle Daviaud initiated discussion on the use of a core package of services
as a principal strategy towards equity in health care provision. She
described the process of attempting to define a core package of PHC services,
conducted by researchers and health officials in South Africa. Aspects of equity
which could be enhanced through the introduction of a core package were
identified, as well as some of the difficulties of implementation. Bill Hsiao
and Eleuther Tarimo pursued the issue further, sharing country experiences of
the implementation of affordable and sustainable core packages of services.
Former Philippines health minister, Alfredo Bengzon, emphasised the
importance of intersectoral collaboration in the attainment of equity, drawing
on his experiences in the government of President Cory Aquino.
Monitoring progress towards equity in health care provision
David McCoy and Lucy Gilson discussed the development of systems for
monitoring and evaluation which specifically identify and monitor change in key
aspects of health care inequities. A number of focal points for selecting
indicators were identified, including: financial allocation, accessibility,
provision of services, quality of care (including assessments of individual
health programmes), health care decision-making processes, and population
trends. They outlined factors to be considered in the selection of
indicators both to measure and more importantly to drive the process of
change. |
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