Background
Equity / inequity in MNCH
Stakeholders within MNCH policy landscape
The EquiFrame analysis framework
Core concept | Definition |
---|---|
Participation/ inclusivity in development of policies and plans | This looked at the extent to which a policy or plan provided for (i) mechanisms (or representation) for communities to participate in, claim and benefit from entitlements in national systems and/or (ii) stakeholder engagement in its development and/or (iii) dissemination to key stakeholders or the general public |
Equity considerations in budgets and resource allocation | This looked at the extent to which policy or plan incorporated inequity metrics (e.g. deprivation) in public budget resource allocation |
Non – discrimination | This examined whether the policy or plan supported the rights of vulnerable groups to have equal opportunity in receiving health care |
Individualized services (also referred elsewhere as acceptability [26]) | This examined the extent to which a policy or plan supported the rights of vulnerable groups to receive individually tailored services to meet their needs and choices |
Entitlement: | This looked at whether the policy or plan stipulated how vulnerable groups qualified for specific benefits relevant to them |
Access | This looked at whether the policy or plan supported vulnerable groups in terms of their physical, economic, and information access to health services |
Quality | This examined whether the policy or plan supported quality services to vulnerable groups through highlighting the need for evidence-based and professionally skilled practice |
Efficiency | This examined the extent to which a policy or plan supported efficiency by providing a structured way of matching health system resources with service demands to address health needs of vulnerable groups |
Effectiveness (Evidence-based focus) | This examined whether the policy or plan used best evidence and practises to optimize health outcomes. |
Accountability: | This examined whether the policy or plan under review specified to whom, and for what, services providers were accountable |
Do no harm/ Safety | This examined whether the policy or plan under review provided for minimization of risks during healthcare delivery |
Cultural responsiveness | This looked at whether the policy or plan under review ensured services responded to the beliefs, values, gender, interpersonal styles, attitudes, cultural, ethnic, or linguistic, aspects of the person. |
Intersectionality | This examined whether the policy under review took into account intersectionality i.e. going beyond the singular categories that are typically favoured in equity-driven analyses (e.g., sex and gender in sex and gender based analysis) and also beyond the kind of enumerated list of determinants of health often found in health impact assessments (e.g. residence, wealth etc.) to consider interactions between categories and determinants simultaneously e.g. impact of gender and education level simultaneously [26]. |
Human resources for health (HRH) | This looked at whether the policy or plan provided for the development (e.g. through training) and maintenance of appropriate HRH to ensure adequate provision of quality healthcare services to women and children |
Infrastructure | This examined whether the policy or plan provided for the development and maintenance of appropriate infrastructure to ensure adequate provision of quality healthcare services to women and children |
Methods
Scoring | Description of scoring category |
---|---|
0 | Concept not mentioned |
1 | Concept only mentioned |
2 | Concept mentioned and explained |
3 | Specific policy actions identified to address the concept |
4 | Intention to monitor the concept was expressed |
5 | Evidence that the specific policy action is (or was) monitored |
Analysis | |
---|---|
Broad Analysis Category | Description of Analysis Category |
Core concept coverage | The percentage of core concepts (CCs) included in the policy out of the total number of CCs. CC coverage = (n/15) × 100 (where: n is the number of core concepts that score above 0; and 15 is the total number of CCs). |
Core concept quality | The percentage of CCs rated as four or five (based on Table 1 scoring), that is, as either stating intention to monitor a specific policy action or there is evidence that the specific policy action is (or has been) monitored. CC quality = (Total number of CCs scoring four or five /15) × 100 (where: 15 is the total number of CCs) |
Overall ranking of policy or plan document | Policies and plans were ranked based on their performance scores in the CC coverage and quality categories. The ranking was given as below: (i) High = if the policy achieved ≥50% on both scores above.
(ii) Moderate = if the policy achieved ≥50% on one of two scores above. (iii) Low = if the policy achieved < 50% on both scores above. |
Quality assurance
Results
Strategy | |||||
---|---|---|---|---|---|
Core concept | Ethiopia Health Sector Transformation Plan | National Health Sector Strategic Plan for Early Childhood Development in Ethiopia | National Adolescent and Youth Reproductive Health Strategy | Ethiopia National Health Care Quality Strategy | Ethiopia National MNH Quality of Care Roadmap |
Participation/ inclusivity in development of policies and plans | 4 | 3 | 4 | 3 | 3 |
Equity considerations in budgets and resource allocation | 4 | 4 | 4 | 4 | 1 |
Non - discrimination | 3 | 3 | 3 | 3 | 3 |
Individualized services | 3 | 3 | 3 | 4 | 2 |
Entitlement | 3 | 2 | 3 | 1 | 1 |
Access | 4 | 4 | 3 | 4 | 4 |
Quality | 4 | 4 | 4 | 4 | 4 |
Efficiency | 4 | 3 | 4 | 2 | 1 |
Accountability | 3 | 2 | 3 | 3 | 4 |
Do no harm/ Safety | 3 | 0 | 3 | 4 | 3 |
Cultural responsiveness | 3 | 1 | 1 | 0 | 0 |
Effectiveness (Evidence-based focus) | 4 | 4 | 4 | 4 | 4 |
Intersectionality | 0 | 0 | 0 | 0 | 0 |
Human resources for health | 4 | 4 | 3 | 3 | 3 |
Infrastructure | 4 | 3 | 3 | 3 | 3 |
Strategy | |||||
---|---|---|---|---|---|
Core concept | Ethiopia Health Sector Transformation Plan | National Health Sector Strategic Plan for Early Childhood Development in Ethiopia | National Adolescent and Youth Reproductive Health Strategy | Ethiopia National Health Care Quality Strategy | Ethiopia National MNH Quality of Care Roadmap |
Core concept coverage | 93% | 87% | 93% | 87% | 87% |
Core concept quality | 53% | 33% | 33% | 40% | 27% |
Overall ranking of policy or plan document | High | Moderate | Moderate | Moderate | Moderate |