Can significantly greater equity be achieved through targeting?
---------------------------------------------------------------
18 KEY STATEMENTS
1. Focusing on equity is a step towards social justice.
2. Equity and social justice in health are one and the same.
3. We can no longer ignore our obligation to search for greater eq-
uity in health.
4. There is an absence of a serious fight for greater equity in our
professions... and that is not a historical accident.
5. The current dearth of epidemiological data on rich-poor health
differentials in low-income countries is actually not a surprise or
coincidence either: it is a deliberate omission.
6. Other than generating more of those data (broken down by income
quintile), we need to commit ourselves as soon as possible to do
something with such data to correct existing inequities and then use
the data to track equity issues.
7. There is a renewed interest in poverty alleviation and equity
among us, but it is still top-down; it ignores the contributions of
the poor themselves. One can see a set-up for yet another failure
here.
8. We need to make PHC what it should have been from the outset -a
public sector driven vehicle fostering true equity in health. (Priva-
tization will never lead us to such a path). All will depend on how
decisively and quick a shift to greater beneficiaries' control oc-
curs.
9. Communities - and not cut-off points - are the best qualified to
identify the poor among themselves thus judging relative poverty.
10. Many currently proposed approaches to resolve health problems,
including those of the World Bank, focus on targeting.
11. It is a fallacy to propose targeting as an alternative to PHC as
originally conceived.
12. Individual targeting is equivalent to the discredited Selective
PHC approach: "Go for the worst cases, fix them, and improve the sta-
tistics". But where are the sustainable changes to avoid the recur-
rence of the same problems and mistakes to be seen
13. Targeting keeps 'a semblance' of equity.
14. Targeting can and does stigmatize the poor creating second-class
citizen that can be manipulated.
15. Waiver schemes for the poor have proven mostly catastrophic.
16. Individual targeting is not a substitute for a more re-distri-
butive public policy. Geographic targeting has probably more poten-
tial.
17. Starting with targeting interventions as the central thrust to
achieve equity is the wrong approach; it pursues what is rather a
'mirage of equity'. It tacitly blames the most vulnerable for being
where they are and tends them a rescuing hand.
18. Let inputs on ways out of non-equity-redressing targeting schemes
come from the more directly affected themselves. Devoting our ener-
gies to facilitate such a process will be a big leap forward for all
of us.
Claudio Schuftan
Hanoi, Vietnam
mailto:aviva@netnam.vn
--
Send mail for the `AFRO-NETS' conference to `afro-nets@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-afro-nets@usa.healthnet.org'.