1) Cameroon conducted bottleneck analyses in 2013-2014 and 2015-2016 using the EQUIST tool to identify barriers to health coverage and prioritize interventions. 2) The EQUIST tool assesses coverage determinants for deprived populations and prioritizes bottlenecks to address. 3) The 2015-2016 analysis involved multiple stakeholders and provided a more quantitative analysis of severity of bottlenecks compared to previous analyses.

1. USING EQUIST FOR
BOTTLENECK ANALYSIS
Cameroon’s experience.
Dr.
AMANI
Adidja
MD
MPH
ENAP
FORUM
Dakar,
31Oct-­‐5th
Nov
2016

2. PROCESS
• 2013-2014 Bottleneck analysis based on the 6
pillars of the health system and the key
interventions
• More of a shopping list – Severity of
bottleneck not quantified
• 2015- GFF initiative: Investment case
• 2016-Capacity building on Equist for the
situational analysis=è>> Sharpened analysis
• Review and update the newborn operational

3. About EQUIST
• EQUIST : The EQUitable Impact Sensitive Tool
Medium-term analysis and strategic
planning tool to improve child and maternal
health as well as nutrition equity in
developing and middle-income countries
• Assessing coverage determinants for deprived
populations
• Prioritizing bottlenecks to be addressed

4. PARTICIPANTS
• The process was highly consulative and
participative
• MoH: Different Departments, EPI, HIV
• Consultants
• National Institute of Statistics
• Partners: WHO, UNICEF, UNFPA, UNAIDS, WB
Bilateral: GIZ
• Professional associations
• Civil Society

5. Coverage Bottleneck Framework
Social
Norms
Availability
of
essenFal
commodiFes
Geographic
access
Financial
affordability
Social
Acceptability
Enabling
Environment
Policies/
legislaFon
Budget/
expenditures
Governance
Ini9al
U9lisa9on
dis-­‐con9nui9on
Poor
Quality
Effec9ve
coverage
Adequate
coverage
Non-­‐U9lisa9on
In-­‐accessibility
Un-­‐affordability
Un-­‐availability
Un-­‐acceptability
Coverage
Determinant
Absolute
BoDleneck
Quality
of
care
Con9nuity
&
9ming
poor
quality/adequate
coverage
discon9nui9on/u9liza9on
Contribu9ng
BoDleneck
Rela9ve
BoDleneck

6. BoRle
Neck
analysis
e
service

7. ADDED
VALUE
OF
THE
EQUIST
1.
Définir
les
populaFons
prioriFaires
2.
Prioriser
les
sujets
de
santé
3.
Prioriser
les
intervenFons
4.
Prioriser
les
goulots
5.
Analyser
les
causes
des
goulots
6.
SélecFonner
les
stratégies
7.
EsFmer
l’impact
et
le
coût-­‐efficacité

8. CHALLENGES
• Availability of updated validated data for the tool to
generate information needed ( Source: DHS, MICs,
Child Mortality estimates, coverage surveys,…)
• Ability to select the relevant the information generated
by EQUIST for the investment plan
• Proper use of the tool at the regional and district levels
• High speed internet connection needed to use the tool
easily
• Adolescents: data needed
• CRVS : Comprehensive evaluation ongoing

9. Lessons learned
• Garbage in , garbage out= the quality of data
used to populate the tool is very important
• Availability of updated validated data for the tool
to generate information needed ( Source: DHS,
MICs, Child Mortality estimates, coverage
surveys,…)
• Need to associate districts and stakeholders in
the field
• enough time for bottleneck analysis and
development of scenarios
• The technical support should continue countries
need to be accompanied all along the process

10. Lessons learned
• Adolescents health- bottleneck analys was done
aside
• Improving data quality and completeness upfront should
be at the center of the GFF preparation in countries
• Search and gather all existing required data well in
advance to optimize the time.
• Need to collect disaggregated data to have an impact