Article (Scientific journals)
How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal
Paul, Elisabeth; Deville, Céline; Bodson, Oriane et al.
2019In International Journal for Equity in Health, 18 (195)
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Keywords :
Universal health coverage; Equity; Global reports; Policy documents; Low- and middle-income countries; Benin; Senegal
Abstract :
[en] - Background: Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. - Methods: We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. - Results: Most of the documents analysed do not define equity in the first place, and speak about “health inequities” in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguous – especially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rights – but also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socio-economic, geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. - Conclusions: While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.
Research center :
IRSS - Institut de recherches en Sciences Sociales - ULiège
Disciplines :
Political science, public administration & international relations
Public health, health care sciences & services
Special economic topics (health, labor, transportation...)
Author, co-author :
Paul, Elisabeth  ;  Université de Liège - ULiège > Tax Institute
Deville, Céline ;  Université de Liège - ULiège > Faculté des sciences sociales > Sociologie du développement
Bodson, Oriane ;  Université de Liège - ULiège > Département des sciences sociales > Economie politique et économie de la santé
Sambieni, N'koué Emmanuel ;  Université de Liège - ULiège > Faculté des sciences sociales > Faculté des sciences sociales
Thiam, Ibrahima;  Université de Thiès
Bourgeois, Marc  ;  Université de Liège - ULiège > Département de droit > Droit fiscal
Ridde, Valéry;  Institut de recherche pour le développement
Fecher-Bourgeois, Fabienne ;  Université de Liège - ULiège > Faculté des sciences sociales > Economie politique et économie de la santé
Language :
Title :
How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal
Publication date :
December 2019
Journal title :
International Journal for Equity in Health
Publisher :
BioMed Central, United Kingdom
Volume :
Issue :
Peer reviewed :
Peer Reviewed verified by ORBi
Name of the research project :
ARC Effi-Santé
Funders :
FWB - Fédération Wallonie-Bruxelles [BE]
Available on ORBi :
since 19 January 2020


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