This document discusses equity and access to healthcare. It defines equity as services being accessible based on need rather than ability to pay or location. Access is defined as the ability to get healthcare of a specified quality and cost. The principles of equity are equal access and utilization for equal need, and equal quality of care for all. Inequities in access are due to issues with legislative frameworks, organizational operations, and resource constraints. Relevant groups facing inequities include those defined by income, social class, geography, education, ethnicity, and gender.

1. EQUITY AND ACCESS TO
HEALTH CARE
KIYEMBA BOB SAVIO

2. OUTLINE
• Definitions
• Principles
• Relevant groups for consideration
• Inequities in access to healthcare

3. DEFINITIONS
• Equity is were by services are accessible on the basis of need rather
than on geographical location or ability to pay.
• Access to health care is the ability to secure a specified set of
healthcare services, at a specified level of quality, subject to a
specified maximum level of personal inconvenience and cost, while in
possession of a specified amount of information (Oliver & Mossialos
2004)
• Equality is were by every individual has equal opportunity to make
the most of their lives and talents.

4. Equity and access to healthcare
• Health equity arises from access to the social determinants of health,
specifically from wealth, power and prestige.
• In order to achieve health equity, resources must be accessible based
on an individual need-based principle
• Access to health care should be determined by actual need for
services rather than ability to pay or geographic location

5. PRINCIPLES OF EQUITY
1. Equal access to available care for equal need
• Those with equal needs have equal opportunities to access health
care (horizontal equity) and,
• Those with unequal needs have appropriately unequal opportunities
to access health care (vertical equity).
2. Equal utilization for equal need
• Those who have an equal need for health care make equal use of
health care
3. Equal quality of care for all

6. STEPS IN ACHIEVING EQUITY
• Ensuring fairness
• Implementing uniform rules for eligibility and charges for
services across the country
• Measures to reduce waiting-times for those availing of public
services
• Giving special attention to certain disadvantaged groups

7. RELEVANT GROUPS FOR CONSIDERATION
These include those defined by;
• Income, the poor most times cannot afford health care resources
which are costly. In Tanzania, the wealthier families were far more
likely to take their children to healthcare provider as compared to the
poor families (Schellenberg, 2003)
• Social class, those who are better connected to individuals providing
the resources live long and healthier lives (House, 1988)
• Geographical location, Urban areas are normally more advantaged as
compared to rural areas.

8. CONT. RELEVANT GROUPS FOR
CONSIDERATION
• Education, an individual may not go to seek health care if
he/she doesn’t know the ills of the failure to do so.
• Ethnicity, members of ethnic minorities are often left out in
distribution of health resources. Sometimes they are also
poor an unable to afford health services.
• Gender, females are many times prioritized leaving out men

9. INEQUITIES IN ACCESS TO SERVICES
They are divided in three broad headings:
1. Issues related to the legislative/regulatory framework
2. Issues related to organizational and operational matters
3. Issues flowing primarily from resource constraints

10. 1. Issues related to the legislative/regulatory
framework
a) Access to public hospitals
• Being sure of getting a hospital quickly when you need treatment
• Reducing on the waiting lists and waiting times for some procedures
• Fair designation of beds as public or private
b) Access to Primary Care Services
• Universal access without user charges

11. 2. Inequities related to organizational and
operational matters
a) Geographic distribution of services
• Equitable distribution of health services nationally and within urban
areas
b) Integration of Services
• Individualized care plans for people requiring multiple supports is the
degree of co-operation
c) Validation of Waiting Lists
• Measures to reduce waiting-times for those availing of public services

12. Cont. Inequities related to organizational and
operational matters
d) Staffing arrangements
• There is limited recruitment of all types of staff, this leads to self–
referral to hospital emergency departments, making access more
difficult for those genuinely in need of the hospital service.
e) Access to Information/Education
• Equity of access to information about services can help people
maintain and improve their health and reduce their need to access
treatment services.

13. Cont. Inequities related to organizational and
operational matters
f) Special access problems for some groups
• The way in which services are organized can pose particular
access problems for some groups e.g. people with
disabilities, teenagers, refugees among others.
3. Issues flowing primarily from resource constraints

14. References
• Harkin, A. M. (2001). EQUITY OF ACCESS TO HEALTH SERVICES. Dublin:
The Institute of Public Health in Ireland.
• House JS, Landis KR, Umberson D (July 1988). "Social relationships
and health". Science. 241 (4865): 540–
5. Bibcode:1988Sci...241..540H. doi:10.1126/science.3399889.
• Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D,
Mshinda H, Bryce J (February 2003). "Inequities among the very poor:
health care for children in rural southern
Tanzania". Lancet. 361 (9357): 561–6. doi:10.1016/S0140-
6736(03)12515-9. PMID 12598141. S2CID 6667015
• Oliver. A., & Mossialos. E. (2004) Equity of access to health care:
outlining the foundations for action. Epidemiol Community Health
2004;58:655–658. doi: 10.1136/jech.2003.017731