Having a
skilled health professional during childbirth can save the life of a woman and
her child. But, in many parts of the world and within many countries, the
presence of a health worker during childbirth is often a luxury.
If a woman is
poor, she is even more likely to deliver without support, putting herself and
child at risk.
In
Indonesia, this is a familiar story for poor women. Twenty years ago, only
women in the % of the population gave birth with support from a skilled
attendant.
Through
recognizing the inequalities and targeting programmes towards the poorest
populations, Indonesia has been able to improve the number of births attended
by skilled personnel among the poorest population out births in the perio.
However, nearly all births among the % of the population were supported.
"While
we have worked hard to reduce the health inequalities in Indonesia, they still
persist," says Ms Rustini Floranita, WHO National Professional Officer and
focal point for gender, equity and human rights in Indonesia. "We need to
continue to find ways to uncover and target these gaps so that the most
disadvantaged populations have the same health care as the richest
populations."
New WHO tool shows within-country inequalities
across the globe
To help
countries like Indonesia monitor health inequalities, WHO developed a new
toolkit called the Health Equity Assessment Toolkit (HEAT). HEAT is a software
package that utilizes data from the WHO Health Equity Monitor and enables
health professionals and researchers to explore the health inequalities in
their countries. Additionally, users can compare the state of inequality in
their country with other countries.
Besides
data on the proportion of births attended by skilled personnel, HEAT users can
assess variations in coverage of immunization, antenatal care, contraception,
and breastfeeding, to name a few of the indicators covered.
In April,
WHO hosted a workshop in Indonesia and participants from the Ministry of
Health, the National Statistical Office of Indonesia, academia, and other UN
agencies, how to assess the country's inequality data in HEAT. At the workshop,
participants learned that Indonesia is increasing the women's and children's
health intervention coverage fastest among the most disadvantaged populations,
including the poorest, the least educated and rural residents in most of
indicators.
When
comparing Indonesia with neighbouring countries, the gaps are more profound. In
parts of South-East Asia and Western Pacific regions some countries are
providing almost complete coverage for skilled birth attendance in all
populations based on economic status, education and place of residence. And, in
other countries the gaps are even higher than those in Indonesia.
"The
'built-in database edition' of HEAT was received very well by the workshop
participants," says
Floranita.
"It facilitates analysis and reporting on health inequality and provides
interactive and customised tables and graphs that can be downloaded and used.
Once we're able to import our own data, we'll be able to monitor even more
inequalities."
Utilizing
the data in HEAT and other data from household surveys, health facility data,
censuses, civil registration, and vital statistics, participants from the
workshop plan to develop a national report on state of health inequality in
Indonesia, which will help the country ensure no one is left behind in the
future.
Equity in the global agenda
Equity is
at the heart of Agenda for Sustainable Development. In pledging to achieve the
Sustainable Development Goals (SDGs), countries have committed to leave no one
behind. focuses on ensuring healthy lives for all at all ages, positioning
equity as a central issue in health, while calls for a reduction in inequality
within and between countries to promote the inclusion and empowerment of all.
However, realizing
equity requires identifying where there are inequalities in the first place,
and then monitoring the progress made at reducing them.
"Strong
health information systems that collect, analyse and report disaggregated data
covering all health areas are essential for achieving health equity," says
Ahmad Reza Hosseinpoor, WHO Technical Officer in the Department of Information,
Evidence and Research. "HEAT provides evidence on the state of health
inequality and can help countries set priorities and establish equity-oriented
policies, programs and interventions."
WHO/A
Kari
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