Incorporating Concern for Health Equity Into Resource Allocation Decisions: Development of a Tool and Population-Based Valuation for Uganda

Fan Yang*, Kenneth R. Katumba, Giulia Greco, Janet Seeley, Elizabeth Ekirapa-Kiracho, Paul Revill, Susan Griffin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Health economic analyses that simultaneously address the concerns of increasing population health and reducing health inequalities require information on public preferences for using healthcare resources to reduce health inequalities and how this is valued relative to improving total population health. Previous research has quantified this preference in the form of an inequality aversion parameter in a specified social welfare function. This study aimed to elicit general population's views on health inequality and to estimate an inequality aversion parameter in Uganda. Methods: Adult respondents from the general population were recruited and interviewed using survey adapted from an existing questionnaire, including trade-off questions between 2 hypothetical healthcare programs. Data on participants’ demographic and socioeconomic characteristics and health-related quality of life measured by 5-level version of EQ-5D were collected. Results: A nationally representative sample of 165 participants were included, with mean age of 37.1 years and mean 5-level version of EQ-5D at 0.836. Most respondents indicated willingness to trade-off some total population health to reduce health inequality. Translating the preferences into an Atkinson inequality aversion parameter (14.70) implies that health gain to the poorest 20% of people should be given approximately 6 times the weight of health gains to the richest 20%. Conclusions: Our study suggests it is feasible to adapt questionnaires of this type for a Ugandan population and this approach could be used to measure public aversion to health inequality in other settings. The elicited inequality aversion parameter can be used to support the assessment of health inequality impact in economic evaluation in Uganda.

Original languageEnglish
Pages (from-to)134-141
Number of pages8
JournalValue in Health Regional Issues
Early online date8 Jun 2022
Publication statusPublished - 1 Sept 2022

Bibliographical note

Funding Information:
Funding/Support: This project was funded by the UK Research and Innovation as part of the Global Challenges Research Fund through the Thanzi la Onse (Health of All) research program (grant number MR/P028004/1).The authors thank the study participants for taking part in this study and the 2 interviewers (Aniitah Kyamugabwa and Menya Abdumagid) and 2 mobilizers (Betty Nakachwa and Peter Mutazibwawo) for their great work. We are grateful for the outstanding support of the administrative staff from Centre for Health Economics, University of York, York, England, UK (Alex Rollinger, Steph Richards). The authors also thank the Uganda Ministry of Health, especially Dr. Tom Aliti, for the support offered to the approval and implementation of the study.

Publisher Copyright:
© 2022 International Society for Health Economics and Outcomes Research


  • health inequalities
  • priority setting
  • resource allocation
  • Uganda

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