Skip to main content

Table 5 An example of important considerations regarding implementation

From: SUPPORT Tools for evidence-informed health Policymaking (STP) 10: Taking equity into consideration when assessing the findings of a systematic review

There is a greater likelihood that disadvantaged children compared to more advantaged children will be exposed to greater health risks, have less resistance to disease, and will therefore have higher mortality rates. These inequities are compounded by reduced access to health services. Even public subsidies for health frequently benefit rich people more than poor people. Implementing interventions to reduce child mortality will not necessarily reduce these inequities and may, in some cases, even increase them. Consideration should thus be given to strategies designed to reduce inequities, such as the provision of more affordable and accessible health services [31]. These strategies may target poor people or they may be implemented universally. Situations in which targeting or universal coverage might be more appropriate include [31]:

Targeting more likely to be appropriate

Universal coverage more likely to be appropriate

• High risk groups easy to identify

• High risk groups hard to identify

• Intervention only needed by children at risk

• Intervention needed by everyone

• Intervention only protects those who receive it

• Intervention has a spill-over effect

• Intervention is widely provided through the public sector

• Intervention is widely provided through the private sector

• Spontaneous demand for the intervention is low

• Spontaneous demand for the intervention is high

• Health services are unable to cover the whole population

• Health services are able to cover the whole population

Universal coverage may be a more appropriate strategy for vaccines, which are needed by everyone and which have spill-over effects (decreasing the risk of infection for both those who are vaccinated and others). However, in order to also reduce inequities in coverage, additional targeted strategies may be needed such as those that address problems with regard to differences in health service accessibility or to a lack of demand for vaccinations in disadvantaged populations.