A Travelling Seminar on the Attainability and Affordability of Equity in Health Care Provision, Workshop Proceedings, The Philippines, June 28 - July 5, 1997

Through a series of presentations and plenary and small group discussions, participants sought to better understand:

• factors affecting the attainability and affordability of equity
• strategies to promote equity in health care provision
• the trade-offs which may be necessary in the implementation of strategies
• positive spin-offs and unintended consequences of different strategies
• ways of monitoring progress towards equity in health care provision.

Economics professor Bill Hsiao presented his view of the attainability and affordability of equity in health care provision, outlining a number of prerequisites for achieving greater equity. Noting the tendency of leaders to focus on financing strategies, he stressed that human resource development, management capacity and information systems were equally important factors in the attainment of equity. Are equal health services affordable? By definition, argues Hsiao, yes - if expenditure  equals revenue. But adequate revenue generation and its allocation and use require leadership, political will and savvy. In turn, these requirements depend on public support and satisfaction with the quality of service provision.

Gerald Bloom argued that the first step for governments was to recognise their inability to ensure equal access to all health services, so that they can concentrate    on measures that yield the greatest benefits. Restructuring of the health sector was the first major task toward equity, which entailed: placing equity at the centre of strategic plans setting clear objectives for improving access to basic health services formulating strategies for best use of available resources and monitoring progress. In addition, Bloom considered options for financing increases in the funding of basic health services once the size of the public health budget has been determined. Continuing the theme of health sector restructuring as a critical strategy towards equity, provincial governor Rosario Diaz outlined the process of decentralisation of public health administration in the Philippines. The experience of the Cotabato province illustrated that governance, service integration and equity can be enhanced through devolution.

South African efforts to achieve greater equity in health care provision were reviewed and assessed. In background papers to the Seminar, Diane McIntyre spelt  out the dimensions of inequity in South Africa, while David Harrison summarised health care developments since 1994. Peter Barron provided a critical appraisal of some of the main strategies towards equity adopted by the Ministry of Health. Emmanuelle Daviaud initiated discussion on the use of a core package of services as   a principal strategy towards equity in health care provision. She described the process of attempting to define a core package of PHC services, conducted by researchers and health officials in South Africa. Aspects of equity which could be enhanced through the introduction of a core package were identified, as well as some of the difficulties of implementation. Bill Hsiao and Eleuther Tarimo pursued the issue further, sharing country experiences of the implementation of affordable and sustainable core packages of services.

Former Philippines health minister, Alfredo Bengzon, emphasised the importance of intersectoral collaboration in the attainment of equity, drawing on his experiences in the government of President Cory Aquino.

David McCoy and Lucy Gilson discussed the development of systems for monitoring and evaluation which specifically identify and monitor change in key aspects of health care inequities. A number of focal points for selecting indicators were identified, including: financial allocation, accessibility, provision of services, quality of care (including assessments of individual health programmes), health care decision-making processes, and population trends. They outlined factors to be considered   in the selection of indicators both to measure and more importantly to drive the process of change.