Abstract
BackgroundAlthough health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years.MethodsWe reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system.ResultsWe found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains.ConclusionThese findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.
Highlights
Health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked
The underlying social determinants which lead to poorer health outcomes among the disadvantaged need to be given special attention in order to reduce inequities in health status [7,8]
We have demonstrated marked health inequities within a local population which had ready access to a well-developed health care program with relatively high utilization, high coverage of services, substantial childhood mortality impact, and a long-term commitment to equity
Summary
Health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years. Issues of inequities in health have received increased attention in recent years. Many discussions of health equity focus on the disparities of health program inputs such as staff and services relative to need, all of which are avoidable and unjust [1,2,3,4,5,6]. The underlying social determinants which lead to poorer health outcomes among the disadvantaged need to be given special attention in order to reduce inequities in health status [7,8]. Those individuals with the poorest health status should receive more health care and other services to address their greater need. The increased attention being given to reducing health inequities arises from the obvious fact that, even though the opportunity to be healthy is a basic and universal human right, health systems are failing to reach the poorest of the poor, health disparities are increasing, and the opportunity for a healthy life is denied to billions of people around the world [9,10,11]
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