Erika Placella, Health Advisor Eastern Europe and Central Asia, SDC
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. The reduction of inequalities within and among countries is also central in the SDGs agenda. Equity and inclusion are core principles of SDC general mandate and almost all country strategies and corresponding health programs target the poorest and most marginalized people, and aim at ensuring their access to quality and affordable services and resources for their health.
With the support of IDS, SDC embarked in a reflection aiming at raising awareness and providing a common and practical understanding of equity and inclusion in a rights-based approach to health. Based on concrete case studies within SDC programs, the idea is to define some guiding principles for inclusive approaches to health to be applied in programme implementation, and establish a common set of minimum equity- and inclusion-related standards and indicators.
As a first step, a group composed by 10 persons, mainly from SDC country offices, has been set up. The participants identified three main themes on which to focus and reflect. Looking beyond the public health system to identify the social, economic and political forces shaping inequity and exclusion and the factors that generate political will to tackle these issues or lead to gaps in implementation of government commitments, has been defined as a crucial topic. The second theme is related to the decentralization and local accountability for equity and inclusion, including central-local government relations, the role of civil society- and faith-based organizations, and the design of participatory institutions for local service oversight. Finally, the group considered that cross-cutting work on data and methodology, including quantitative, qualitative and participatory research and survey approaches and integration of service-user perspectives into performance monitoring, should be given special attention.
After a launching webinar, a workshop has been held in Tirana, Albania, in September 2016. This face-to-face meeting allowed to defining key concepts and issues on equity in accessing health. Challenges related to political dynamics of equity and inclusion, accountability and drivers of inequity, have also been identified, as well as some relevant entry points for action. Finally, some recommendations on how to apply an equity lens have been addressed.
Four concrete case studies within the SDC health portfolio in Eastern Europe and Central Asia have then been selected, in relation to which the group will work as an action learning set. The case studies correspond to four different phases of the program life cycle: identification of a new project in Kyrgyzstan, design of a new project in Moldova, elaboration of a new country strategy in Moldova, external mid-term review of a mental health project in Bosnia and Herzegovina. The idea is to make sure that equity issues are rightly and timely addressed at different stages. The participants will be actively involved in reflecting and commenting the documents, participating in workshops or interacting with key stakeholders involved in the four processes. IDS will provide technical backstopping and guidance.