Abstract
BackgroundEquity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies.MethodsWe analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities.ResultsMost of the documents analysed do not define equity in the first place, and speak about “health inequities” in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguous – especially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rights – but also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socio-economic, geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity.ConclusionsWhile equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.
Highlights
Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it
Equity seems inherent to the pursuance of UHC: for instance, the World Health Report 2008 defines universal coverage reforms as “reforms that ensure that health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection” [2]; the World Health Organisation (WHO) believes that equity is an intermediate objective of UHC [3]; and the WHO Consultative Group on Equity and Universal Health Coverage urges countries to commit to fairness, equity and rights to health in policymaking [4]
This paper aims to explore on the one hand how the multidimensional concept of equity has been approached in key global UHC reports and policy documents, and on the other hand whether and how this understanding impacts on UHC policies at country level
Summary
Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. A narrative review of peer-reviewed literature published in English between 2005 and 2013 retrieved approximately 9000 papers from PubMed via the search words, ‘universal health coverage/care’ and ‘equity/inequity’ [9] It is a controversial, ambiguous concept that is intertwined with a number of other concepts such as fairness (which is a broader concept and focuses on the worst-off), equality, social justice, social inclusion, solidarity, altruism, and rights to health [4, 6, 11,12,13,14,15]. Rockefeller Foundation, Save the Universal Health Coverage: A Commitment to Close the Gap [36]. - Associations of equity with UHC and other concepts: The document considers equity is part of UHC: “This vision of UHC embodies principles of equity in access to and use of services, quality of the services people obtain, and financial protection for people needing health services” - Associations of equity with UHC and other concepts: The document considers equity is part of UHC: “This vision of UHC embodies principles of equity in access to and use of services, quality of the services people obtain, and financial protection for people needing health services” (p. 5); UHC is about health and “moving closer to UHC is about equity, development priorities, social inclusion and cohesion” (p. 10); UHC “is a concept that is fundamentally about equity” (p. 12)
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