Methods to promote equity in health resource allocation in low- and middle-income countries: an overview

James Love-Koh, Susan Griffin, Edward Kataika, Paul Revill, Sibusiso Sibandze, Simon Mark Walker

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Unfair differences in healthcare access, utilisation, quality or health outcomes exist
between and within countries around the world. Improving health equity is a stated
objective for many governments and international organizations. We provide an
overview of the major tools that have been developed to measure, evaluate and
promote health equity, along with the data required to operationalise them.

Methods are organised into four key policy questions facing decision-makers: (i) what
is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity.

Benefit incidence analysis can be used to estimate the distribution of current public
health sector expenditure, with geographical resource allocation formulae and health
system reform being the main government policy levers for improving equity.
Techniques from the economic evaluation literature, such as extended and
distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity.

Methods from the economics literature can provide policymakers with a toolkit for
addressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings.
Original languageEnglish
Article number6
Number of pages12
JournalGlobalization and Health
Issue number1
Publication statusPublished - 13 Jan 2020

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© The Author(s). 2020

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