Abstract
BackgroundEquality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries also. Other concepts of fair distribution of health such as equity of access to medical care may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries.MethodsA framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia.ResultsIn Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status.ConclusionThe goal of equality of health status may not be appropriate in many developing country situations. A stepwise approach based on progressive redistribution of medical services and resources may be more appropriate. This conclusion challenges the views of health economists who emphasise the need to select a single health equality goal and of development agencies which stress that equality of health status is the most important dimension of health equity.
Highlights
Equality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries
In this paper we argue from a practical perspective that in many developing country situations the sufficiency issue is likely to be of minor importance compared to issues of practicality, efficiency and focus in tackling health inequities
We suggest that while the goal of equality of health status may lead to the conclusion that equitable access to health care is an insufficient condition for health equity, it does not mean that equitable access and utilisation goals may not be more relevant and lead to more efficient interventions for tackling health inequalities
Summary
Equality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries . Other concepts of fair distribution of health such as equity of access to medical care may not be sufficient to equalise health outcomes but, they may be more practical and effective in advancing health equity in developing countries. Inequalities in health between population groups exist in all countries. Health inequalities exist largely because people have unequal access to society's resources including education, job security, clean air and water and health care – factors that society can do something about. A number of definitions of health equity have been proposed. The four most prominent in the literature are 'equality of expenditure per capita', 'equality of access', 'distribution according to need' and 'equality of health status'. Economists have argued that these definitions are (page number not for citation purposes)
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