Working to improve health equity: How do we plan for it? How do we evaluate it?

Staff involved: Angela Lawless

A focus on health equity is a primary health care principle that underpins practice and programs. Whilst a focus on equity is often an important component of community health work it is often absent from evaluations (Jolley et al 2004). Perhaps this is not surprising as health equity is a difficult concept with many dimensions and remains a challenging area of practice for health services.

In order to assist practitioners with planning and evaluating the equity component of their work SACHRU is developing a tool for application to the small-scale, local interventions that characterise much of community health's work. Much of the literature deals with 'big picture' equity issues and interventions such as social policy initiatives or regional interventions and is not easily applicable to local community health work.

As always the rationale for an intervention - what you know about the issue and why you choose to tackle it in a particular way- is a critical step in the planning process and an important foundation for the evaluation. Clear program logic allows for better evaluation.

To plan and evaluate the equity component of their work practitioners need a clear understanding of:

  • health equity that is congruent with primary health care principles,
  • possible pathways to health equity that interventions may have an impact upon
  • questions and issues to consider in both planning and evaluation
  • possible indicators and data sources
  • evaluation methods appropriate to the particular intervention

Achieving health equity requires more than the programmes and services within the scope of community health. The goals and objectives of community health equity work need to be stated in realistic, understandable and achievable terms. However community health, with its strong commitment to health equity has done much innovative and useful work in this area and this should be recognised and disseminated. Evaluation is an important step in this process.

Work is continuing on development of this tool and we hope to trial its use later in 2006. We welcome input from practitioners who would like to provide feedback on the tool as it is developed or to trial its use.