(Dar es Salaam) In this session Prof John W. Frank (pictured below) from the University of Edinburgh in the UK reviewed the methodological advantages of the Scottish Government annual reports that monitor socio-economic health inequalities1 – as manifested in about a dozen routinely collected health statistics at the national level, across 6505 local neighbourhoods.
Potential challenges were highlighted in interpreting these data and the widely used summary (Relative and Slope) Indices of Inequality used in the Scottish reports — especially for policy-making. Specific recommendations were made by the presenter in a 2011 publication2, for revising these annual Reports of the Scottish Government – most of which have since been implemented.
The transferability of this approach to Tanzania, to achieving SDG#10 – Monitoring and Reducing Health Inequalities (HIs) – was then discussed, including a refinement to reduce costs and simplify the necessary data collection.
According to Prof Frank, that refinement, for the Tanzanian context, has been proposed in our recent paper in Journal of Global Health3, to overcome the shortcomings of current national census and other socio-economic data at the population level.
The refinement involves the use of anonymized, routinely collected administrative data from other (non-health) sectors, to estimate the average SES of each Tanzanian Ward or District, against which to map and calculate routinely collected health outcomes, especially those from local health-care facilities.
It is argued that, one put in place, this approach would be not only less expensive, but also less technically complex, and more nationally self-reliant (“kujitegemea”) than the current approach.
The current approach relies heavily on infrequent, costly, and technically complex Demographic and Health Surveys funded by development assistance donors, but typically insufficiently statistically powerful to track HIs for less common health outcomes, such as maternal mortality, at even the Regional, let alone District level.
1. Long-Term Monitoring of Health Inequalities: Headline Indicators. Scottish Government Health Analytical Services Division, Edinburgh. 2012. https://www.gov.scot/
2. Frank JW, Haw S. Best-Practice Guidelines for Monitoring Socioeconomic Inequalities in Health Status: Lessons from Scotland. The Milbank Quarterly 2011; 89(4):658-693.
3. Frank JW, Pagliari C, Geubbels E, Mtenga S. New forms of data for understanding LMIC health inequalities: the case of Tanzania. Journal of Global Health Dec 2018; 8(2):020302 doi:10.7189/jogh 08.020302.
Professor John W. Frank [MD, CCFP, MSc, FRCPC, FCAHS, FFPH, FRSE, LLD] (pictured above) trained in Medicine and Community Medicine at the University of Toronto, in Family Medicine at McMaster University, and in Epidemiology at the London School of Hygiene and Tropical Medicine. He served with VSO/CUSO in Mbeya, Tanzania in 1976-9 as a Medical Officer and teacher of Medical Assistants.His appointments include: Professor (now Emeritus) at the University of Toronto, at the Dalla Lana School of Public Health, since 1983; founding Director of Research at the Institute for Work & Health in Toronto from 1991 to 1997; and inaugural Scientific Director of the Canadian Institutes of Health Research – Institute of Population and Public Health (2000-2008).From 2008 to 2018, he was the founding Director of an Edinburgh-based Unit, funded by the Medical Research Council and the Scottish Chief Scientist Office: the Scottish Collaboration for Public Health Research and Policy. The Collaboration has sought to develop and robustly test novel public health policies and programs to equitably improve health status in Scotland, through the convening and ongoing support of researcher/research-user consortia.Prof Frank holds a Chair in Public Health Research and Policy at the University of Edinburgh, where he was appointed Director of Knowledge Exchange and Research Impact for the Usher Institute in late 2017. In mid-2018, he became an Honorary Public Health Consultant to NHS Scotland, attached to the Scottish Public Health Observatory. #