developing city wide equity gauges: rationale and pitfalls. pierre ngom african population and...
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Developing City Wide Equity Gauges:Rationale and Pitfalls.
Pierre Ngom
African Population and Health Research Center (APHRC)
Population Council, Nairobi
The World is becoming increasingly urban
Good News, BUT……..
In SS-Africa, Cities are not Engines for Growth
• Between 1970 and 1995, African urban population grew by 4.7% per year, while GDP dropped by 0.7% per year
• Industrialization did not accompany the African urban boom
SOURCE: WORLD DEVELOPMENT REPORT 1999/2000
Poverty is sky-rocketing in urban areas:THE CASE OF KENYA
45
5248
53
29
49
26
50
0
10
20
30
40
50
60
Percent
Kenya Rural Areas Urban Areas Nairobi
1992 1997
Mortality is higher among the urban poor
NEONATAL MORTALITY RATES, 1990-1998 (Based on Bi r ths in the 5 Year s Preceeding Surveys)
0 1 0 20 30 40 50 60 70
Benin, 1996Bur kina Faso,
Camer oon, 1998C.A.R., 1994
Cote d' Ivoir e, 1994Comor os, 1996
Ghana, 1 998Kenya, 1 998
Madagascar , 1 992Mal i , 1995/ 96
Mozambique, 1 996Namibia, 1 992
Niger , 1997/ 98Niger ia, 1990Rwanda, 1992Senegal , 1997
T anzania, 1 996T ogo, 1 998
Uganda, 1 995Zambia, 1996/ 97Zimbabwe, 1994
Neonatal M or tal i ty R ate
Other Ur ban
Ur ban P oor
The urban poor have less access to health services
PRENATAL CARE (Received in Fi r st Tr imester ) - Bi r ths 3-5 year s bef or e survey date
0 1 0 20 30 40 50 60 70
Benin, 1996Bur kina Faso,
Camer oon, 1998C.A.R., 1994
Cote d' Ivoi r e, 1994Comor os, 1996
Ghana, 1 998Kenya, 1 998
Madagascar , 1 992Mal i , 1995/ 96
Mozambique, 1 996Namibia, 1 992
Niger , 1997/ 98Niger ia, 1990Rwanda, 1992Senegal , 1997
T anzania, 1 996T ogo, 1 998
Uganda, 1 995Zambia, 1996/ 97Zimbabwe, 1994
P r enatal C ar e
Other Ur ban
Ur ban P oor
City-wide Health Equity Gauges to:
• Measure inequalities in health status and health care between the urban poor and other urban residents. Comparison with other national sub-populations (eg., rural areas) may be useful
• Raise awareness about above inequalities in order to inform and influence policy
Methodological Pitfalls to Avoid:
1. The 1000 Data Sources Trap: data gullibility does not pay. Use a few relevant and comparable data sets.
2. The Mathusalem Trap: avoid old data, unless you have comparable recent ones.
3. The Einstein Trap: do not be over-sophisticated. Choose indicators that you can easily interpret to policy-makers and program implementers.
Partnering is important
1. Team up with partners who are concerned with health equity issues and who have been dealing with it. Avoid partners who will not listen, and who have no influence.
2. Do not put the cart before the horse: involve all key partners of the city-wide equity gauge from start.
Have a Clear Work Plan
1. Always plan ahead: Line up the issues you would like to address in a given period.
2. Have a Strategy: Define the means you will rely on to achieve the above goals: workshops, media materials, etc.
3. Be transparent: Clearly define the role of each partner, share all documents related to the project with all partners.
Thank you