Considerations For Incorporating Health Equity in Project Design_Luna_5.12.11

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Considerations For Incorporating Health Equity in Project Design_Luna_5.12.11

  1. 1. Considerations for Incorporating Health Equity into Project Designs <br />CORE Spring Meeting<br />Jennifer Luna<br />May 12, 2011<br />
  2. 2. Considerations for Incorporating Health Equity into Project Designs<br />Purpose:<br />Present the health equity guidance document and checklist developed by MCHIP<br />Guidance document posted on www.mchipngo.net<br />Checklist in draft – not posted<br />Provide an opportunity for dialog about elements of this guidance<br />Hear from PVOs about their own experiences<br />Receive feedback on the guidance <br />
  3. 3. Agenda<br />Presentation on guidance and checklist<br />Small group discussions about questions in the checklist<br />Opportunity to provide feedback<br />Presentations by<br /> CHS-URC, Ecuador <br />CRWRC, Bangladesh<br />CARE Nepal<br />
  4. 4. Development of guidance<br />Collaborative effort<br />USAID, MCHIP, CORE, other technical experts<br />Overview of equity in CSHGP projects; Virtual TAG; Input from technical experts; Literature review<br />Discussion sessions:<br />CORE: Fall meetings 09 & 10; Spring 10 (gender equity); Spring 11<br />MCHIP: July 2010 – March 2011<br />Presentation at Woodrow Wilson Center, April 2011<br />Process continues <br />
  5. 5. The guidance<br />Targets professionals who design and implement projects<br />Specifically community-oriented projects<br />Broader application to other project<br />Provides a systematic process that ensures<br />Equity is incorporated into designs<br />Improvements can be demonstrated and explained<br />A shared understanding among stakeholders <br />
  6. 6. The guidance<br />Reference document <br />Considerations for Incorporating health Equity into Project Designs: A Guide for Community-Oriented Maternal, Neonatal, and Child Health Projects<br />Check list<br />Series of questions/ discussion points about project designs<br />Workbook<br />Series of formats for keeping track of decisions<br />
  7. 7. The guidance<br />Not prescriptive; does not promote one approach<br />Presents series of concepts & approaches to take into consideration and decisions to be made<br />Leads to a coherent health equity strategy<br />Serves as a basis for dialog among stakeholders<br />
  8. 8. The guidance: definition of health equity<br />Health equity is both the improvementof a health outcome of a disadvantaged group as well as a narrowing of the difference of this health outcome between advantaged and disadvantaged groups--without losing the gains already achieved for the group with the highest coverage.<br />(MCHIP)<br />
  9. 9. Guiding assumptions<br />Addressing equity means more than working in a disadvantaged geographical region<br />Means reaching most disadvantaged within that region<br />Making comparisons over time of health outcomes between disadvantaged and advantaged groups.<br />Requires understanding and deciding how to handle underlying conditions<br />Obtaining high coverage levels depends on decisions made along a continuum<br />From narrowly targeting a disadvantaged group to a universal approach aimed at all groups.<br />
  10. 10. The guidance<br />Six- Step Process:<br />Understand the equity issues in the project area<br />Identify the disadvantaged group on which to focus<br />Decide what is in project’s manageable interest to change<br />Define equity goals, objectives, and a project-specific definition of equity<br />Determine equity strategies and activities<br />Develop equity-focused M&E <br />
  11. 11. Incorporating Health Equity into Project Design<br />Guiding Assumptions:<br />Addressing equity means more than simply working in a disadvantaged geographical region; it means reaching the most disadvantaged within that region and making comparisons over time of health outcomes between disadvantaged and advantaged groups.<br />Developing strategies to address inequity requires understanding and deciding how to handle the underlying conditions.<br />Obtaining high coverage levels depends on decisions made along a continuum, from narrowly targeting a disadvantaged group to a universal approach aimed at all groups.<br />Step 1: Understand health equity issues<br />Identify inequities in health outcomes; magnitude of differences<br />Understand underlying issues and barriers<br />Continue detailed equity planning<br />yes<br />Step 2: Identify disadvantaged group to focus on<br />Step 3: Decide what is in manageable interest to change? <br />No<br />Maintain awareness of health inequities; Go to step 6<br />Step 4: Define equity goals, objectives, operational definition<br />Step 5: Determine equity strategies and activities<br />Step 6: Develop equity-focused M&E<br />
  12. 12. Questions?<br />Questions about the process<br />Experience with some of these steps in programs?<br />
  13. 13. Six-step process used to analyze equity in CSHGP grants<br />Analyzed CSGHP grants completed Final and Mid-term evaluations 2010 - Jan. 2011<br />FE & MTE reports<br />Follow-up phone calls<br />To see if grantees followed 6 steps, even without guidance document or checklist<br />To write up briefers on the processes used by grantees to incorporate health equity<br />
  14. 14. Results of analysis of CSGHP grants<br />Evidence of already following steps, although no project followed all steps equally well<br />Enough details to write briefers<br />Strongest: Understanding health outcomes & underlying conditions; developing strategies<br />Weakest: Equity goals, objectives and a project specific operational definition<br />M&E could be improved<br />
  15. 15. Small group discussions<br />Time:<br />20 minutes for small group discussion<br />10 minutes for larger group discussion<br />Divide into groups 6-7 people<br />At least one person with project implementation experience<br />Choose a facilitator and a recorder<br />Record on flipchart paper<br />
  16. 16. Small group discussions<br />Start with step 1 of the checklist - Copies provided<br />Read questions associated with step1 (A & B)<br />Discuss:<br />How you have addressed these questions in your own programs?<br />What questions have been problematic to answer or that you have not considered?<br />What advice would you give professionals trying to answer these questions? <br />Suggestions for the guidance?<br />Continue with other steps<br />

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