Assessing linkages of global health programs with poverty, equity and vulnerability: Policy implications for improving health's contribution to development programs

PURPOSE To assess whether poverty reduction and health equity objectives are adequately addressed in international health program design and evaluation process. Particular attention will be placed on USAID, where reduction of widespread poverty was recently added to the overall goal of foreign assistance.

DATA Three main sources of data: a) indicators for 85 USAID health strategic frameworks; b) evaluation studies from selected countries, and c) large scale USAID-funded surveys and other sources of data

METHODS We begin with content analysis/desk review of USAID Country Mission Health Sector Strategies; then add primary and secondary analysis of large-scale DHS and RHS data. Finally, secondary analysis of multivariate data from rigorous health program evaluations, as well as primary analysis of USAID/GOE vulnerability assessments in Ethiopia.

RESULTS We found a very limited number of specific poverty reduction/equity/vulnerability indicators in current USAID country strategies. However, there are significant disparities in health status and service use across a range of reproductive and child health indicators. Moreover, identifying non-economic vulnerabilities to food/nutrition insecurity and under-five mortality are crucial for effecting targeting.

POLICY IMPLICATIONS Demonstrated health disparities and the limited poverty-equity linkages found in USAID health strategies, suggest opportunities for strengthened programming through: a.Development of new strategies to address barriers affecting the provision of health goods/services to the poor. b.Strengthened policy, advocacy and donor coordination to support health's input to poverty reduction. c.Expanded participatory approaches to “investing in people”, including involvement and local ownership of the underserved. d.Establishing criteria for determining health sector effectiveness in foreign assistance for poverty-inequity reduction.