EquitAble and the EquiFrame manual
EquiFrame: A Framework for the Analysis of Human Rights and
Vulnerable Groups in Health Policies
WWW.EQUITABLEPROJECT.ORG
PROF. MALCOLM MACLACHLAN
EQUITABLE PROJECT MANAGER
MLACHLAN@TCDC.IE
DR. HASHEEM MANNAN
EQUITABLE SENIOR RESEARCH FELLOW
MANNANH@TCD.IE
MS. JOANNE MCVEIGH
EQUITABLE RESEARCHER
JMCVEIGH@TCD.IE
How Can a University Change the World?
The Power of ideas can transform
the ideas of Power
Frenk, 1995
EquitAble and the EquiFrame manual
Policies should be written for all but should be sensitive to different types of need
To promote Health for All, focus on equitable health care rather than equal health care
Marginalized, discriminated groups bear a disproportionate share of health problems
States must recognize specific needs of groups that confront particular challenges through
disaggregation of health policies
Project EquitAble
o FP7 funded, 4-year collaborative research project; researchers
from Ireland, Norway, Sudan, Namibia, Malawi & South Africa
o Led by Centre for Global Health, Trinity College Dublin
o Produce empirical knowledge on health care access for vulnerable
people in resource poor settings in Africa
o 5 Work Packages:
EquiFrame
o Novel policy analytical framework; assesses human rights and social inclusion
in health policies
o Assesses policy content or ‘policy on the books’
o Identifies degree of commitment of a health policy to 21 Core Concepts of
human rights and 12 Vulnerable Groups, underpinned by ethos of universal,
equitable and accessible health service provision
o Particular focus on persons with disabilities (outlined in EquiFrame as a
vulnerable group)
o 70 health policies analyzed in total
o 4 target countries: Sudan, Malawi, Namibia, & South Africa: 51 health policies
Impetus
 Prevailing focus on process of health policy development; A paucity of
literature that outlines an analytical framework to analyze ‘policy on the books’
 Many health policy practices developed and researched in higher
income countries and subsequently transferred to low- and middle-income
(LMIC) countries; Variability of context makes generalization problematic
 EquiFrame: A framework to guide policy analysis in terms of ‘policy on the
books’ and doing so from a LMIC perspective
Country Profiles
Sudan – Large proportion of
population displaced
Malawi – Chronic poverty and high
disease burden compete for meagre
resources
Namibia – Population highly
dispersed
South Africa – Despite relative
wealth, universal and equitable access
to health care not yet attained
Development
.
Literature
Searches/
Discussions
Initial
Ideas
Project Meeting
Khartoum
Conference
Presentations
Universal,
Equitable,
Accessible Health
Services
Feedback
workshops
Draft
Framework
EquiFrame
Results
Analysis of 70
Health Policies
Consultation
Workshops
Revised
Framework
Core Concepts
1.Non-discrimination
2.Individualized services
3.Entitlement
4.Capability based services
5.Participation
6.Coordination of services
7.Protection from harm
8.Liberty
9.Autonomy
10.Privacy
11.Integration
12.Contribution
13.Family resource
14.Family support
15.Cultural responsiveness
16.Accountability
17.Prevention
18.Capacity building
19.Access
20.Quality
21.Efficiency
Vulnerable Groups
Core Concept Quality
Each Core Concept received a rating of quality of commitment to Core Concept within
the given policy document
Score on continuum of 1-4:
1.
Concept only mentioned
2.
Concept mentioned and explained
3.
Specific policy actions identified to address Concept
4.
Intention to monitor Concept expressed
Summary Indices
1. Core Concept
Coverage
• Number of Core Concepts mentioned out of 21
Core Concepts
2. Vulnerable
Group Coverage
• Number of Vulnerable Groups mentioned out of
12 Vulnerable Groups
3. Core Concept
Quality
• Number of Core Concepts rated as 3 or 4 (stating a
specific policy action or intention to monitor
action) out of 21 Core Concepts
4. Overall
Summary
Ranking
• (i) High = policy achieved ≥50% on all of three
indices above
• (ii) Moderate = policy achieved ≥50% on two of
three indices above
• (iii) Low = policy achieved<50% on two or three of
three indices above
Common Health Policies
EquiFrame: can provide both within and across country comparative analysis of health policies in terms of
Core Concepts of human rights and inclusion of Vulnerable Groups
Policy
Malawi
Namibia
1
2
HIV AIDS Policy
Disability Policy
High
Moderate
Moderate
Moderate
South
Africa
High
Low
4
Tuberculosis Policy
Moderate
Moderate
Moderate Low
3
Mental Health
Moderate
High
Moderate
5
6
7
Malaria
National Health policy
Reproductive Health Policy
Low
Low
Low
Low
Low
High
Moderate
8
Drug/medication Policy
Moderate
9
Gender Policy
Low
Moderate
Sudan
Low
Low
Low
High
Low
Disability Policy
Policies
VG%
CC%
% of CC quality Overall
between 3 to 4 Quality
Namibia National Policy
on Disability
58%
95%
43%
Moderate
South Africa the National
Rehabilitation Policy
41%
47%
19%
Low
Malawi National Policy
On Equalisation Of
Opportunities For
Persons With Disabilities
17%
57%
67%
Moderate
Sudan National Disability
policy
42%
62%
24%
Low
EquiFrame Findings
51 policies analyzed across Namibia, Sudan, South Africa & Malawi:
oMost frequently mentioned Vulnerable Groups across Disability, TB, HIV/AIDS policies:
Disabled persons, Suffering from chronic illness, and Youth
internal validity of EquiFrame methodology
oAll Core Concepts mentioned in at least one policy analyzed across project countries
construct validity of categories used
o4 countries had policies scored High, Moderate and Low; each country differed in proportion
of policies falling in each range
oSome very strong policies, serious shortcomings in others & country-specific
patterns
oHealth sectors of each of these states face significant challenges in addressing
inequities found to be present within a number of current African health policies
Project EquitAble
Strategic Impact
o Provide better understanding of universal access to health care and provide an
invaluable resource for health systems and policy decision makers working to
meet universal access to health care, by setting out clear evidence base for
proposed actions
o First known study to address this wide a range of vulnerability factors within a
single data-gathering model
Measuring disability in context of other vulnerability factors may assist in
disability mainstreaming in public health planning/delivery, and in
appreciating that disability frequently interacts with other marginalizing
factors to doubly disadvantage people with activity limitations
o Collect data from contexts where we have little information
Useful for health care systems and disability sectors in Africa & EU aid
programmes for developing countries
There is nothing more unequal than the
equal treatment of unequal people
Thomas Jefferson
Extensive gap in access to health care between disparate groups in low as well as
high-income countries well established
Equity in health care is an astute and feasible political aspiration
If human rights and social inclusion do not underpin policy formation, it is
unlikely that they will be inculcated in service delivery
Through its discernment of policy commitment to human rights and vulnerable
groups, EquiFrame, devised under Project EquitAble, stands to promote the
United Nations directive of ‘health for all’, with its implicit assumption of
universal and equitable access to health care.
Sources
Project website: www.equitableproject.org
Manual: Freely downloadable peer reviewed
EquiFrame manual, available on project website
Papers currently in press:
Amin et al. (2011). EquiFrame: a framework for
analysis of the inclusion of human rights and
vulnerable groups in health policies. Health &
Human Rights (in press).
Mannan et al. (2011). Core Concepts of human
rights and inclusion of vulnerable groups in the
disability and rehabilitation policies of Malawi,
Namibia, Sudan and South Africa. Journal of
Disability Policy Studies (in press).