Surveillance for equity in primary health care: policy implications from international experience
Taylor, C.E.
International Journal of Epidemiology 21(6): 1043-1049
1992
ISSN/ISBN: 0300-5771 PMID: 1483808 DOI: 10.1093/ije/21.6.1043Document Number: 324022
Epidemiological methods of surveillance allow public health officials to use equity indicators (fertility, mortality, and causes of death) to improve health care for the poor, thereby achieving an effective and efficient primary health care system and a moral objective. The indicators should be simple and measurable. Each community is responsible for monitoring its members and should begin with registering all families. Simple retrospective verbal autopsy methods should be used initially. Continuous data collection (e.g., rapid assessment procedures and simple demographic surveys) should monitor high risk subgroups. Surveillance provides feedback so health workers and community leaders can discuss how to address health problems. Interventions should be simple and inexpensive and attack only priority demonstrated needs. Development specialists have discredited many field demonstrations of successful surveillance for equity, claiming they cannot be reproduced at the national level. The Model County Project in China is an example of how ideological commitment to equity can improve health care. Between the early 1960s and late 1970s, it used barefoot doctors to monitor the health of and provide health care to neighbors. Local health cooperatives and the barefoot doctors promoted preventive measures and equitable distribution of food. The Project's activities resulted in a sizable reduction of infant mortality (275-50). In the 1980s, however, China shifted to privatization which reversed the earlier priority of equity. It has since realized the effects of this shift and now reemphasizes equity. In the Punjab, India, village-based auxiliary nurse-midwives conducted effective continuous epidemiological surveillance, focusing on the most needy families, and provided health care. This Narangwal Project improved both equity and cost effectiveness. Other effective surveillance projects were in rural Haiti (affiliated with the Schweitzer Hospital), the Kakamega Project in Kenya, and in Jamkhed, India.