PHA-Exch> Research to action to address inequities: the experience of Equity Gauge

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org

 *Research to action to address inequities: the experience of the Cape Town
Equity Gauge*

* *

Vera Scott*, Ruth Stern*, David Sanders, Gavin Reagon, Verona Mathews -
School of Public Health, University of Western Cape, South Africa

*International Journal for Equity in Health – February **2008, **7**:6 doi:
10.1186/1475-9276-7-6*

* *

*            *Available online PDF file [41p.] at:* *
http://www.equityhealthj.com/content/pdf/1475-9276-7-6.pdf



"…..While the importance of promoting equity to achieve health is now
recognised, the health gap continues to increase globally between and within
countries. The description that follows looks at how the Cape Town Equity
Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is
endeavouring to tackle this problem.



We give an overview of the first phase of our research in which we did an
initial assessment of health status and the socio-economic determinants of
health across the subdistrict health structures of Cape Town. We then
describe two projects from the second phase of our research in which we move
from research to action.



*The first project, the Equity Tools for Managers Project*, engages with
health managers to develop two tools to address inequity: an Equity
Measurement Tool which quantifies inequity in health service provision in
financial terms, and a Equity Resource Allocation Tool which advocates for
and guides action to rectify inequity in health service provision.



*The second project, the Water and Sanitation Project*, engages with
community structures and other sectors to address the problem of diarrhoea
in one of the poorest areas in Cape Town through the establishment of a
community forum and a pilot study into the acceptability of dry sanitation
toilets.



*Methods*

A participatory approach was adopted. Both quantitative and qualitative
methods were used. The first phase, the collection of measurements across
the health  subdistricts of Cape Town, used quantitative secondary data to
demonstrate the inequities. In the Equity Tools for Managers Project further
quantitative work was done, supplemented by qualitative policy analysis to
study the constraints to implementing equity. The Water and Sanitation
Project was primarily qualitative, using in-depth interviews and focus group
discussions. These were used to gain an understanding of the impact of the
inequities, in this instance, inadequate sanitation provision.

* *

*Results*

The studies both demonstrate the value of adopting the GEGA approach of
research to action, adopting three pillars of assessment and monitoring;
advocacy; and community empowerment. In the Equity Tools for Managers
Project study, the participation of managers meant that their support for
implementation was increased, although the failure to include nurses and
communities in the study was noted as a limitation. The development of a
community Water and Sanitation Forum to support the Project had some notable
successes, but also experienced some difficulties due to lack of capacity in
both the community and the municipality.



*Conclusion*

The two very different, but connected projects, demonstrate the value of
adopting the GEGA approach, and the importance of involvement of all
stakeholders at all stages. The studies also illustrate the potential of a
research institution as informed 'outsiders', in influencing policy and
practice…."
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