Pressing Research Needs to

Advance an Equitable Health Policy

Nalaka Mendis

University of Colombo Sri Lanka Conference on

International Collaborative Research and Health Ethics 

Jakarta, Indonesia

29 November-01 December 2005

Health Care Universal Values

• Equity of access

• Quality

• Efficiency

• Human Rights

Health Care Importance of equity in Sri

Lanka Extent of reference to equity

in

Public documents

Education/training activities

Public debate

Professional discourse

Equitable Health Policy or

Equitable Access to Health Care

Issues on focus

Equity Access to Needs of Services Individual

Key conceptsGeneral problems

• Understanding

• Definition

• Measurement

• Comparison

Health needs Concept and Definition

• Normative need

• Felt need

• Expressed need

• Comparative need

• Pretreatment health

• Capacity to benefit

Health needs Concept and Definition

This can be either

• What an individual requires to achieve or maintain health

• An estimation of the programmes required

to improve the health of populations.

Access to Health Care Concept and Definition

Ability to secure a

• Specified set of health care services

• At a specified level of quality

• Subject to specified maximum level of inconvenience/cost

• While in possession of a specified amount of information

Concept and Definition Equity Principles

• Equal access to health care for those in equal need of health care

• Equal utilization of health care for those in equal need of health care

• Equal (or rather equitable)health outcomes ( as measured by QALE)

• Horizontal equity• Vertical equity

Advancing an equitable Health Policy areas needing study

Supply side

Regulation

Resources

Orgasnisation

Services

Funding

Demand side

Population variables

Advancing an equitable Health Policy,research needs-

Regulation

• Expression given to the concept in Policy

• Policy frame work to realize equity• Continuing monitoring mechanisms• Responsible agency

Advancing an equitable Health Policy, research needs-

Resources

Distribution of

Facilities

Manpower

Equipment

Services

Advancing an equitable Health Policy, research needs-

organisation

• Decentralisation

• Community participation

Advancing an equitable Health Policy, research needs- funding

• Social insurance

• General taxation

• Third party payment 

• Out of pocket payment

Advancing an equitable Health Policy, research needs-

individual/ community variable

Income Geography

Ethnicity Education Gender Knowledge

Social class Preference

Advancing an equitable Health Policy,research needs

Summary• Value attached to equity

• Need to clearly define concepts

• Define, improve and secure equity of access

• Factors influencing equity

supply side, demand side

• Identification of priority areas for research