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  Health and Equity



In low- and middle-income countries, inequalities are leaving millions of people without access to services and resources for their health. Gender, ethnicity, age, and disability, combined with the lack of sustainable social and financial protection mechanisms, are among the main grounds for exclusion and inequitable access to health.

Addressing inequities and inclusion is a very complex process which goes far beyond improving access to quality health services at population and individual level.

In response to this strategic goal of the SDC, a learning trajectory on ensuring equity and inclusion for health aimed to increase awareness and understanding of these issues among SDC staff involved in the design, implementation and steering of health projects and programmes in the Eastern Europe and Central Asia region, and to stimulate sharing of relevant knowledge and experience, in order to inform the development of guidance for future work.

The work was led by Erika Placella (SDC Health Advisor for Eastern Europe and Central Asia) and supported by Alex Shankland, Hayley MacGregor and Gerry Bloom from the Institute of Development Studies (IDS), UK, and involved colleagues from Swiss Embassies and SDC offices in Eastern Europe and Central Asia and SDC Bern. The resulting guidance note includes key challenges and five key principles to be taken into consideration at different points in SDC’s programme cycle:

Key Principle 1: Ensure that you understand not only statistical patterns of health inequality but also forms of social exclusion, the specific groups that are most vulnerable to exclusion, and the norms, social relations (including provider attitudes and behaviour) and networks that influence whether and how marginalised people access health information and care.

Key Principle 2: Ensure that you have identified the right implementation partners and potential allies to enable the programme to make a difference for equity and inclusion.

Key Principle 3: Ensure that programmes are both responsive and adaptive, with an approach characterised by “learning by doing” and governance arrangements that strengthen inclusion and representation of marginalized groups.

Key Principle 4: Ensure that programmes have robust equity and inclusion monitoring systems that include opportunities for service users – especially the most marginalised and vulnerable – to provide inputs to programme evaluation and review, including commenting on health care worker attitudes.

Key principle 5: Ensure that you understand the wider structural conditions shaping inequity and exclusion in the health sector and in the country as a whole, including not only barriers to change but also coalitions and alliances that have the potential to strengthen equity and inclusion.