Enhancing equity through service statistics in an integrated health system in Haiti

An important goal in community-based primary health care is equity. However, equity is difficult to assess at the local level on an ongoing basis. Hôpital Albert Schweitzer (HAS), in rural Haiti, has had an explicit policy for 15 years “to assure that services are equally available to all and assure that those with greatest need are served.” While special studies are carried out occasionally to assess equity among the 6 areas (“functional units” or FUs) served by HAS, routinely collected service statistics are also used to monitor and evaluate equitable service provision. This paper will present the range of service statistics that can be examined from an equity perspective and also discuss the difficulties inherent in this approach. For example, the number of pediatric consultations at the dispensaries, per 100 children, is higher in the 3 lowland FUs (with higher socioeconomic status [SES]), whereas the number of such consultations at mobile clinics is higher in the 3 mountainous FUs. Mobile clinic sessions and rally posts are also more numerous in the more remote areas. Other service statistics examined include adult consultations, family planning consultations, children's vaccinations, prenatal visits, postnatal home visits, HIV tests, malaria tests and children's malnutrition status. One limitation of service statistics for monitoring equity is that the quality of data reporting may also vary among service areas. Thus, it is imperative that staff who are familiar with the field work be involved in evaluating the results.