Equity Gauge Project: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
13 September 1999
EQUITY GAUGE PROJECT: BRIEFING BY HEALTHLINK

Document:
The Equity Gauge Project: briefing notes

SUMMARY
The chairperson, Dr Nkomo outlined the challenges facing this committee and how Healthlink can support them. Healthlink outlined the Equity Gauge Project.

MINUTES
Dr Nkomo pointed out that the government does not have sufficient resources to permit full-time researchers for parliamentarians. Researchers are recruited on an hourly basis.

Dr Nkomo outlined the following challenges faced by parliamentarians, namely:
lack of resources; lack of capacity to fundraise; the perception that they are seen as amateurs and yet they have to pass laws and monitor their implementation as well as assess whether the laws are making an impact on the lives of people.

Dr Nkomo pointed out that the issue of equity is important because there are people with little and they need to have access to health care. It is difficult to measure whether the Department is making a difference in this area.

The partnership the Department of Health has with the Kaizer Foundation is going to assist in determining how much the department had done for those who have little or nothing. The instrument of measurement is the Equity Gauge Project.

Ms A Ntuli from Healthlink, which is funded by the Kaiser Foundation, outlined the Equity Gauge Project.

There is no record of the discussion that followed this presentation.

Appendix 1:
The Equity Gauge Project: briefing notes

Rationale for the Equity Gauge
International Context
Statistics on equity around the world are alarming.
Despite increasing awareness and attention paid to issues of equity, the gap between the rich and the poor is increasing

South Africa
One of the most unequal countries in the world
Policies of the post 1994 government make explicit commitment to reducing inequality and to promoting equity.

Measurement of equity is an important tool for evaluating the impact of policies and resource distribution.

What is Equity
Equity is a complex concept with many dimensions. Concept entails the idea of "fair shares for all"

A starting point is "equal shares for all" and an important goal of the gauge is monitoring of per capita spending by level of care and by district as well as by province

Components of the equity gauge project include:
Monitoring equity in health and health care
Analysing existing data
Commissioning new research to highlight new aspects of equity

Helping to ensure that information on equity is disseminated

National and provincial legislators supported in using the information to promote equity

The Gauge is designed to measure equity in:
- Health Service indicators including inputs to health care such as financing and personnel and quality of care
- Broad factors affecting health including access to water and electricity
- Health status of the population

In each of these areas some key indicators have been selected. The choice of indicators was influenced by a number of factors including:
Importance of the information for legislators
- Availability of data
- Opportunities for updating information on an annual basis

Work on Measuring Equity to date
- 1997 Clinic survey
Provided information on a range of indicators including infrastructure and quality of care

- 1998 South African Health Review
Analysed a variety of aspects of the South African Health System including financing and human resource distribution.
Inequities at an inter-provincial as well as intra-provincial level were described

1998 Quality of Care in Clinics and Hospitals
Updated the 1997 survey and added new information

Health Service Indicators
Private/Public comparisons
Financing in the Public Sector
Personnel in the Public Sector

Quality of Public Sector Care
Clinic access to water, electricity and telephone
Services available
Drugs availability
Staff knowledge

Determinants of Health
Household access to water
Household access to sanitation
Household access electricity

Health Status Indicators
IMR
MMR
TB
Stunting

Indicators are analysed by:
Province
Rural/Urban
Race
Socio-economic status

Information in the Gauge is drawn from both primary and secondary research
Primary Research :
1997 Clinic Survey
1998 Facilities Survey
1998 South African Health Review

Secondary Research
- Kaiser Funded National Household Survey of Health Inequalities
- Poverty and Inequality in South Africa, Report prepared for the office of the Deputy President
- Health, Nutrition and Population, World Bank Report
- Census brief, 1998

Project Management
Steering Committee:
National and Provincial legislators and HST Board members and staff

Technical Advisory Group:
Academics and researchers specialising in Equity and HST staff