1. Considerations for Incorporating Health Equity into Project Designs CORE Spring Meeting Jennifer Luna May 12, 2011

2. Considerations for Incorporating Health Equity into Project Designs Purpose: Present the health equity guidance document and checklist developed by MCHIP Guidance document posted on www.mchipngo.net Checklist in draft – not posted Provide an opportunity for dialog about elements of this guidance Hear from PVOs about their own experiences Receive feedback on the guidance

3. Agenda Presentation on guidance and checklist Small group discussions about questions in the checklist Opportunity to provide feedback Presentations by CHS-URC, Ecuador CRWRC, Bangladesh CARE Nepal

4. Development of guidance Collaborative effort USAID, MCHIP, CORE, other technical experts Overview of equity in CSHGP projects; Virtual TAG; Input from technical experts; Literature review Discussion sessions: CORE: Fall meetings 09 & 10; Spring 10 (gender equity); Spring 11 MCHIP: July 2010 – March 2011 Presentation at Woodrow Wilson Center, April 2011 Process continues

5. The guidance Targets professionals who design and implement projects Specifically community-oriented projects Broader application to other project Provides a systematic process that ensures Equity is incorporated into designs Improvements can be demonstrated and explained A shared understanding among stakeholders

6. The guidance Reference document Considerations for Incorporating health Equity into Project Designs: A Guide for Community-Oriented Maternal, Neonatal, and Child Health Projects Check list Series of questions/ discussion points about project designs Workbook Series of formats for keeping track of decisions

7. The guidance Not prescriptive; does not promote one approach Presents series of concepts & approaches to take into consideration and decisions to be made Leads to a coherent health equity strategy Serves as a basis for dialog among stakeholders

8. The guidance: definition of health equity Health equity is both the improvementof a health outcome of a disadvantaged group as well as a narrowing of the difference of this health outcome between advantaged and disadvantaged groups--without losing the gains already achieved for the group with the highest coverage. (MCHIP)

9. Guiding assumptions Addressing equity means more than working in a disadvantaged geographical region Means reaching most disadvantaged within that region Making comparisons over time of health outcomes between disadvantaged and advantaged groups. Requires understanding and deciding how to handle underlying conditions Obtaining high coverage levels depends on decisions made along a continuum From narrowly targeting a disadvantaged group to a universal approach aimed at all groups.

10. The guidance Six- Step Process: Understand the equity issues in the project area Identify the disadvantaged group on which to focus Decide what is in project’s manageable interest to change Define equity goals, objectives, and a project-specific definition of equity Determine equity strategies and activities Develop equity-focused M&E

11. Incorporating Health Equity into Project Design Guiding Assumptions: Addressing equity means more than simply working in a disadvantaged geographical region; it means reaching the most disadvantaged within that region and making comparisons over time of health outcomes between disadvantaged and advantaged groups. Developing strategies to address inequity requires understanding and deciding how to handle the underlying conditions. Obtaining high coverage levels depends on decisions made along a continuum, from narrowly targeting a disadvantaged group to a universal approach aimed at all groups. Step 1: Understand health equity issues Identify inequities in health outcomes; magnitude of differences Understand underlying issues and barriers Continue detailed equity planning yes Step 2: Identify disadvantaged group to focus on Step 3: Decide what is in manageable interest to change? No Maintain awareness of health inequities; Go to step 6 Step 4: Define equity goals, objectives, operational definition Step 5: Determine equity strategies and activities Step 6: Develop equity-focused M&E

12. Questions? Questions about the process Experience with some of these steps in programs?

13. Six-step process used to analyze equity in CSHGP grants Analyzed CSGHP grants completed Final and Mid-term evaluations 2010 - Jan. 2011 FE & MTE reports Follow-up phone calls To see if grantees followed 6 steps, even without guidance document or checklist To write up briefers on the processes used by grantees to incorporate health equity

14. Results of analysis of CSGHP grants Evidence of already following steps, although no project followed all steps equally well Enough details to write briefers Strongest: Understanding health outcomes & underlying conditions; developing strategies Weakest: Equity goals, objectives and a project specific operational definition M&E could be improved

15. Small group discussions Time: 20 minutes for small group discussion 10 minutes for larger group discussion Divide into groups 6-7 people At least one person with project implementation experience Choose a facilitator and a recorder Record on flipchart paper

16. Small group discussions Start with step 1 of the checklist - Copies provided Read questions associated with step1 (A & B) Discuss: How you have addressed these questions in your own programs? What questions have been problematic to answer or that you have not considered? What advice would you give professionals trying to answer these questions? Suggestions for the guidance? Continue with other steps