Committee Report on Equity Gauge Project: adoption

SUMMARY
The Committee adopted the proposed programme and Ms A Ntuli and Mr S Khoza from Healthlink briefed the committee.

MINUTES
Committee Programme
Dr Nel (Free State) suggested that item seven under Oversight Programme on Health, be moved up to item four of the programme. The meeting agreed that it should be placed there. The programme was adopted.

Presentation by Healthlink
See Equity Gauge Project briefing notes

Questions from members
Ms Ntlabati (Free State): The word "equity" was central to our struggle we had against apartheid and a definition of equity means more than justice. When you say 54 out of 1000 African children die before their first birthday in rural areas, it means that in urban areas things are better. I disagree with that. We should not confine ourselves to rural areas only.

Ms Ntuli: The statistics are broken into urban and rural as there is need to be specific.

Mr J Tlhagale (North-West): I want to know whether Equity Gauge Project has resources that can be used for deficiencies that occur in our Health system?

Ms Ntuli: The European Union and Kaizer Foundation fund District Project Development. The project supports how these inequalities can be lessened.

Mr Qokolweni (Eastern Cape) commented that statistical figures hide details. He asked what relationship Healthlink has with Department of Health and other departments such as Housing.

Ms Ntuli: There is a partnership between government and Healthlink and we have met to give a report. There is ongoing contact.

The meeting was adjourned.

Appendix 1:

Draft Committee Programme

1 Meetings with Departmental Directors General and Ministers

2 Briefing on Welfare/ Home Affairs/ Health legislation for the remainder 1999

Oversight programme: Health

1. Deployment of doctors to institutions for community service

2. Monitoring progress of the Report on Traditional Healers

3. Monitoring HIV Provincial Pilot Projects.

4. Impact of the TOP Act

5. Clinic building programmes/project and infrastructure

6. Liaising with Department and district health systems

7. Limited Private Practice

Oversight programme: Welfare

1. Integration of 14 Welfare systems

2. Monitoring phasing out of state maintenance grant and checking on support mechanisms e.g. poverty alleviation projects

3. Monitoring the impact of flagship projects

4. Monitoring NGO's role in social community projects

5. ID delivery to disabled community

Oversight programme: Home Affairs

1. State of readiness of the IEC with regard to the Local Government Elections

2. Briefing on International Migration White Paper

3. Briefing progress on ID card system and Birth Registration

4. Traditional Marriages Bill (monitor)

5. The standards of border control mechanisms - site visits

6. Liasing with the National Assembly

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