HEALTH EQUITY, SEXUAL

1
HEALTH EQUITY, SEXUAL REPRODUCTIVE HEALTH IN
MDGs

• Ad Hoc Expert Group Meet on MDGs
• 7 9 MAY 2008

2
PRESENTATION OUTLINE

• Health equity and inequity
• Sexual and reproductive health
• Ethiopia context
• Thematic area and ECA draft report few
  observations
• Comment on suggested additional indicators

3
HEALTH EQUITY, INEQUITY

• Health equity assures all people an equal
  opportunity to enjoy optimum physical,
  psychological, social, and spiritual well being
• Stands for equitable resource allocation
• Health inequity refers to unequal and unfair
  access to and utilization of health services
  across regions and states
• Access determined by clientele situation and
  system related factors

4
HEALTH INEQUITY CONSEQUENCES

• Violation of human right, justice
• Results in social exclusion
• Direct impediment in attaining 3 health MDGs
  (3,4,5), target 2 10 of MDGs 1 7
• Induces capability and QOL poverty

5
INEQUITY SOURCES

• Income
• Gender
• Residence location
• Race
• Ethnicity

6
SEXUAL REPRODUCTIVE HEALTH (SRH)

• Concept gained currency at ICPD 94
• Inadequate SRH services are a serious public
  health QOL issue
• SRH is linked to gender equality (MDG 3),
  HIV/AIDS, Malaria and other diseases (MDG6), MDG
  1 3
• Universal access to SRH was added as a target in
  revised MDG framework a welcome move

7
ETHIOPIA COUNTRY CONTEXT

• Health inequity, SRH major concerns in fact on
  some indicators situation has worsened over time
• ECA draft report section6 lucidly presents
  Progress on Health MDGs in Africa but the case
  study on Ethiopia does not adequately discuss the
  two themes.

8
ETHIOPIA COUNTRY CONTEXT contd

• High MMR, unsafe abortions, low uptake of ante
  natal, natal and post natal services, low
  contraceptive use, high incidence of fistula,
  obstetric emergencies are a serious pointer to
  huge unmet need for SRH services for both genders
  
• Noteworthy progress made in reaching child
  immunization coverage. It is gender neutral too (
  Ethiopia Welfare Monitoring Survey 2004)

9
SOCIALLY EXCLUDED GROUPS IN ETHIOPIA

• Socially excluded groups in Ethiopia can
  include minority groups found in different parts
  of the country with whom dominant classes keep a
  distance. Also, the latter use their products but
  do not share goods and services with the
  minority. They are Menja community of Bonga
  Keffa
• Weito in Amhara Fuga in Guraghe. They suffer
  all forms of exclusion

10
ECA DRAFT REPORT AND HEALTH THEMES

• Section 7 lucidly discusses the link between SRH
  and MDGs 1,3, 6, 7.
• In Section 2 Policies to Address Exclusion inter
  alia mention Ethiopias community health
  extension programme which is highlighted here
• Both above are a strength of the report

11
ECA DRAFT REPORT AND HEALTH THEMES

• Multi-country study by ECA, World Bank and few
  other researches used to effectively document
  health inequities by wealth quintiles and
  residence location
• Gender differences could be added
• Sex disaggregated data required for monitoring
  progress

12
ECA DRAFT REPORT AND HEALTH THEMES

• Under major causes for poor progress on health
  MDGs supply side factors mentioned
  comprehensively
• What about demand side factors? For example,
  reasons why women do not seek obstetric emergency
  care or maternal health services?

13
ECA DRAFT REPORT AND HEALTH THEMES

• They lack knowledge of when to seek
• treatment or do not perceive need have poor
  information of services or lack ability to
  understand health messages may not have
  permission from the family may have more faith
  in traditional healers or other beliefs

14
ECA DRAFT REPORT AND HEALTH THEMES

• Table 6.1 on Progress on the Health MDGs and
  Targets very well presents changes from 1990 to
  2005 under three regions developing, Northern
  and Sub-Saharan
• Another table can be added for recording country
  specific changes

15
SUPPLEMENTARY INDICATORS COMMENTS

• Possible new goal to monitor resource allocation
  to health is APPRECIATED
• 4 new indicators regarding resource allocation
  for health care required
• All proposed indicators in table 6.2 are relevant
  and high priority but table format needs to be
  made more effective

16
SUPPLEMENTARY INDICATORS COMMENTS

• Utilization of natal services could be added with
  pre natal services there are gross inequities
  here
• Access to ARV drugs can be differentiated by
  gender
• PLWHAs face exclusion in employment, housing,
  social interaction, use of basic services such as
  health and education. Indicators could be crafted
  to monitor progress in these areas

17
SUPPLEMENTARY INDICATORS COMMENTS

• Indicators required to monitor utilization of
  male and female SRH services recommended
• Higher uptake of SRH services will impact
  progress towards MDGs 1, 2, 3, 5,6. Their
  linkages discussed
• THANK YOU !!!