Equityinaccesstoinjuryprevention&traumacare

OliveKobusingye,M.B.Ch.B,M.Med(Surg),MPHMakerere UniversitySchoolofPublicHealth

Equityinaccesstoinjurypreventionandtraumacare

• Equityinhealthimpliesthatideallyeveryoneshouldhaveafairopportunitytoattaintheirfullhealthpotential…thatnooneshouldbedisadvantagedfromachievingthispotential,ifitcanbeavoided.

• Equalaccesstoavailablecareforequalneed,equalutilizationforequalneed,equalqualityofcareforall.

WhiteheadM.1990.TheConceptsandPrinciplesofEquityinHealth.Copenhagen:WHO,Reg.Off.Eur.(EUR/ICP/RPD4147734r).29pp.

Reasonswhyinterventionsarenotimplemented

• Interventionsdonotexist

• Interventionsarenotaffordable

• Interventionsarenotappropriateforthesettings– henceknowledgetransfer

• Interventionsrequiretheparticipationofmanyentitiesandwehaveyettofigureouthowtogetthemtoworktogether

Equityinaccess

toinjurypreventionandtraumacare

inLMICs

Thefallacyoflowincomes• Theinjurypreventionfieldhasmadeabigdealofincomecategories

• Incomesare important• Hasincomedisparitybetweenoverrated?• Isincomeagoodproxy?• Whatis/aretheunderlyingfactor(s),andwhyarewenotusingthem?

• Categoriestoobroadtobemeaningful?

Othercategorisations

• Poorandrichcountries

• NorthandSouth

• Developedandundeveloped/

developing

Governance

• Governance:theprovisionofthepolitical,socialandeconomicgoodsthatacitizenhastherighttoexpectfromtheirstate,andthatastatehastheresponsibilitytodelivertoitscitizens.

• Failureofgovernance:failurebythestatetoprovideanessentialgood(service,e.g.ETC),onethatispossibletoprovide,andthatcitizensarereasonabletoexpect

IbrahimIndexofAfricanGovernance

IbrahimIndexofAfricanGovernance

4• categories

14• sub-categories

93• indicators

• Updatedeveryyear

• 54countries

• 33differentdata

institutions

IbrahimIndexofAfricanGovernance

TheSafety&RuleofLaw:

• theextenttowhichallindividualsareprotectedfrombothinternalandexternalthreatstothepeace.

• Thedegreetowhichsocietyissafeandsecureisassessedalongsidetheexistenceofarobustlegalsystem andtransparent,effectiveandaccessibleinstitutions,withinallbranchesofthestate.

IbrahimIndexofAfricanGovernance

Accountability

• Transparency&CorruptioninthePublicSector

• Accesstoinformation• Bureaucracy• CorruptioninGovernment&PublicOfficials• DiversionofPublicFunds• AccountabilityofPublicOfficials• PublicSectorCorruptionInvestigation• ProsecutionofAbuseofOffice

Amuchsimplerindex(OK)

ByDanielKaufmann,Aart Kray andMassimoMastruzzi - WorldwideGovernanceIndicators,PublicDomain,https://en.wikipedia.org/w/index.php?curid=23861869

Lackofaccountability

ByDanielKaufmann,Aart Kray andMassimoMastruzzi - WorldwideGovernanceIndicators,PublicDomain,https://en.wikipedia.org/w/index.php?curid=23861869

AreLMICsdifferentfromLMACs?

• Thesamecountriesmayfeatureinboth

• Thelowaccountabilityprobablyexplainsthelowincomesmorethanthereverse

• Threecategories(equitableaccess):– UnablebutWilling/Caring

– UnableandUncaring– AblebutUncaring

EXAMPLES

LakeVictoria

LifeLinesonLakeVictoria

• 2nd largestlakeintheworld,3,700kmofcoastline,200inhabitedislands,200,000fishermenand700tonesoffishannually,worthUS$400million.

• Estimated5,000drownings annually• 2008- 2010apartnershipofGSMADev Fund,Zain,Ericsson,NationalLakeRescueInstituteandtheKalangala Fishingcommunitypilotedawatersafetyproject

Projectcomponents

• Search&Rescueinfrastructureandpersonnel

• Communication(MaritimeRescueCordCtr)

• Lifejackets– manufacture&distribution

• Localcommunitiesmobilized&engaged

Improvedlakesafety2012

• Partnership:WMO,Ericsson,MTN,UgandaDepartmentofMeteorology,andNationalLakeRescueInstituteintroducedMobileWeatherForecasting forfishingcommunitiesonlakeVictoria…

toenablethemto“makeaninformeddecisionastowhethertheytravel,tradeorfishontheLake”

Accesstopost-crashcare

Country GNI Vitalreg%transportedinambulance IIAG

Angola 5170 No <11 40Benin 790 Yes 11to49 58Botswana 7770 Yes 11to49 78Cameroon 1290 Yes <11 45DRCongo 430 No <11 33Egypt 3140 Yes <11 51Ghana 1770 Yes 11to49 67Libya 12930 Yes <11 35Malawi 270 Yes Noamb service 57Mauritius 9290 Yes 75plus 80

Mozambique 610 Yes Noamb service 52

Accesstopost-crashcare

Country GNI Vitalreg%transportedinambulance IIAG

Angola 5170 No <11 40Benin 790 Yes 11to49 58Botswana 7770 Yes 11to49 78Cameroon 1290 Yes <11 45DRCongo 430 No <11 33Egypt 3140 Yes <11 51Ghana 1770 Yes 11to49 67Libya 12930 Yes <11 35Malawi 270 Yes Noamb service 57Mauritius 9290 Yes 75plus 80

Mozambique 610 Yes Noamb service 52

Whatthen?

• Incomesarenotnecessarilythe(main)ormostrelevantcategorizingfactor

• Shiftdiscoursetoaccountability

• Findwaysinwhichtoassess&communicateaccountabilityinourresearch

• Advocateinwaysthatincreaseaccountability

• Explorehowtoavoidthesustainabilitytrap

A poor man who is unhappy is better off than a rich man who is unhappy.

The poor man still has hope.

He thinks money would help.