Measuring Equity of Reproductive Health Services
Annual Call for Projects 2005
Keywords
Health - Public HealthSummary
Countries committed themselves to the attainment of "universal access to reproductive health for all by 2015" in 1994 at the International Conference on Population and Development (ICPD). However, considerable literature shows unequal use of reproductive health services by population sub-groups. At the Millennium Summit in 2000, the international community set goals and targets to promote improvements in development and health. Three out of eight Millennium Development Goals (MDGs) are related to different aspects of reproductive health. In its January 2005 report, the Millennium Project -- the independent advisory body to the UN working on strategies in achieving the MDGs -- highlighted the importance of sexual and reproductive health services in achieving all eight MDGs.
It is increasingly recognised that achieving international goals and targets related to reproductive health and development is difficult without addressing inequalities in women's receiving services. This requires rigorous evaluation of equity of services in order to understand the sources of inequalities.
Equity in health is broadly defined as the elimination of "avoidable, unfair and unjust differences" in health. More precise definitions focusing on health services define equity in terms of utilisation as the equal treatment of individuals with equal need. Current literature on equity in health mainly focuses on financing of health systems and distribution of resources. How these concerns at the macro level are reflected at the micro level -- in individuals' actual benefit from services -- is, however, studied to a lesser extent. This study will contribute to existing literature by providing an approach to systematic assessment of equity of reproductive health services at the user level.
A variety of factors at the user or health systems level influence women's use of services. The effects of these are modified by the wider context within which health systems function and by other societal influences. It is necessary to develop a means by which complexities of the setting can be captured in a standard format. This study will investigate and explain inequalities among population subgroups through a set of indicators concerning the use by women of reproductive health services (attendance at birth by skilled health personnel, contraceptive use and knowledge of HIV-related prevention practices). These indicators will be used to address key aspects of reproductive health services namely family planning, maternal health and sexually transmitted infections (STIs) and HIV/AIDS.
The overall aim is to develop a profile of instruments that can be applied internationally to appraise the extent to which variable use of reproductive health services are due to health system or user-related factors. The first phase of the research will be conducted in South Africa.
The study will use a combination of research methods that will complement each other. Document analysis on health systems and interviews with key informants involved in different aspects of service provision will provide information on the broader context of services such as structure and organisation including funding, regulatory context, clinical governance issues such as the availability and use of protocols/guidelines, use of audits and priorities. Potential factors associated with reproductive health service use will be identified through conduct of a systematic review and focus groups with users and non-users of services. All these methods will be used to determine the design and sampling of the questionnaire for a cross-sectional community-based survey.
Immediate results of the research will explain the variations in the indicators of access to reproductive health services in one of the most disadvantaged areas of South Africa (the Eastern Cape Province) and this information is expected to influence local policies and programmes thus helping to improve the quality and equitable uptake of health services.
The main output of the research will be a profile of internationally applicable instruments (both qualitative and quantitative) that will aid in better understanding the relative contribution of supply-side or demand-side factors regarding reproductive health service use. The profile is expected to be useful in different country settings in helping to understand the influence that health system factors have on the variable use of reproductive health services. This information will help determine appropriate intervention strategies for attaining the ICPD goal of "universal access" to reproductive health services and related MDGs.
The grant provided by the GIAN for this project totals SFr 160,000
Project Team
Dr. Lale Say , Coordinator, Reproductive Health and Research , World Health Organization (WHO) .
Dr. Karim Abawi , Principal Member, Geneva Foundation for Medical Education and Research (GFMER) .
Dr. Dina Balabanova , Principal Member, Health policy unit , Department of public health and policy , London School of Hygiene and Tropical Medicine (United Kingdom) (LSHTM) .
Dr. Debra Jackson , Principal Member, School of Public Health , University of Western Cape (South Africa) .
Prof. Rosalind Raine , Principal Member, Department of Epidemiology and Public Health , University College London (United Kingdom) (UCL) .
Dr. Regina Kulier , Associated Member, Geneva Foundation for Medical Education and Research (GFMER) .
Dr. Metin Gülmezoglu , Former Member, Reproductive Health and Research , World Health Organization (WHO) .
Prof. Philippe Jaffé , Former Member, Faculty of Psychology and Education Sciences (FPSE) , University of Geneva (Unige) .
Dr. Shawn Koppenhoefer , Former Member, Geneva Foundation for Medical Education and Research (GFMER) .
Ms Lindeka Magnesi , Former Member, Faculty of Psychology and Education Sciences (FPSE) , University of Geneva (Unige) .