Health Equity -- Micro Challentes to Global Responsibilites

Abstract for 2012 Global Conference on Public Health.

Equity at micro level – challenges to global responsibilities.

Kausar S Khan

(278 words)

Injustices of inequities are played out at the micro level, and that too within the households. In developing countries, where State responsibilities towards the poor and vulnerable are seldom the outcomes of policies and programs, and where service delivery ( in health as well as sectors that constitute the social determinants of health) remain inefficient (for various governance issues) people’s role in holding the duty bearers responsible remain a central strategy. In Pakistan, following a review of Norman Daniel’s Benchmarks of Fairness in Health Care, the notion of fairness in health care was introduced at various levels (government, NGOs and community groups). Following the intervention at the community level, a request was made to introduce the idea to villageea.  This challenge led to an alteration in introduction to Benchmarks of Fairness in Health Care, and a way was found  of facilitating community groups for assessing equity at community level. This process was then taken in twenty plus villages (women and men’s groups). Priority setting was also done by these groups to propose priority areas for reducing inequities, and these were then presented at the district level.  Poo responses at the district and national level presented a major challenge for advancing community directed equity agenda. In developing countries, the power centers are far removed from the micro level needs and rights. Addressing this gap is a great challenge which perhaps can be met if global forces can recognize communities right to better health and better conditions that determine health outcomes. Donors represent the global powers that must face this challenge. However, do aid agencies recognize community rights ? This perhaps is the biggest challenge to global responsibilities to equity.