Genuine, professional and original data base along with an honest and sincere analysis is very rare in the developing world. Road maps for development, based on concocted data, infrequently achieve significant results.
The book, “Islamabad Health Equity Model” is the first of its type on this specific theme in the entire region. It provides an evidence based plan which addresses inequities in five different income quintiles in a city of two million population of Islamabad. “The plan” has been successfully tested, and has produced results that have contributed to enhanced quality of life. The city has one of the highest growth rates in the region because of the phenomenon of urbanization.
The “equity roadmap” is developed on the basis of findings, deduced as a result of a comprehensive cross-sectional study, in various (six) sectors of Islamabad. For the study sample, three geographical clusters were taken into account i.e; urban cluster, rural cluster and urban slums cluster. The study was carried out over a period of three months, whereas “Health Equity Model” was conceived three years back by the author.
Study assessed a sample size of 770 households in different sectors of Islamabad. Study design evaluated factors, among multiple segments of population, in relation to different income quintiles and comparison was also made among various sectors / geographical areas of Islamabad. The core indicators taken into account, for assessments of disparities, were; socio-demographic, economic, environmental, behavioral and health. The study therefore created five income quintiles of 20% each to compare various indicators for an assessment of equity in population groups.
The results were a mixture of expected and unexpected findings.
Depending on the educational qualification, the age of marriage among groups varied considerably. Income level reported by respondents reflected a wide range i.e. from Rs. 4000 to Rs. 500,000 per month.
Significant differences were found in the ages of first pregnancy between different income quintiles. Child immunization status varied and interestingly the coverage was found slightly less in higher income quintiles as compared to poor income quintiles.
Pattern of smoking was surprisingly equal in all the segments and income quintiles. 94.2% respondents were employed.
It may be said that by third world standards the health parameters, after three years, had currently attained reasonable benchmark and a good foundation to build upon.
The author goes on in the book to propose an “Equity Based” model that envisages a roadmap, for future, developed to cater for convergence of effective strategies for the most needed. Vision is to provide high quality health care for all and to protect the inhabitants from looming epidemics taking into account the socio economic determinants of health. A unique system is proposed and is created locally. The outcome, as a result of implementation of “equity model”, has shown remarkable progress estimated by “third party evaluation” reports, such as Pakistan Demographic Health Survey 2012-13).
Beyond this book and more in the field of practical efforts the author has endeavored to develop different and special health care packages that match the requirements of different groups of people belonging to that particular class.
The effort to reduce the gap between the rich and poor, vulnerable and privileged, marginalized and blessed is the road to equity. The path is not only difficult it is in contravention to the established cultural prevailing practices. The roadmap however is the first step towards achieving social justice and equity in a society.
Director Health Services,