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 concepts General 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