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CORE Group’s Spring MeetingBaltimore, May 11, 2011
Alex Ergo, PhDBroad Branch Associates
Do MCHIP-Supported Interventions Reach the Poor?
How can we know?
The Maternal and Child Health Integrated Program (MCHIP)
USAID Bureau for Global Health’s flagship maternal, newborn and child health program
Working in well over 30 countries worldwide
MCHIP supports programming and opportunities for integration in: Maternal, Newborn and Child Health Immunization, Family Planning, Malaria,
HIV/AIDS Water & Sanitation, Urban Health, Health
Systems Strengthening
Introduction
MCHIP would like to know whether the interventions it supports reach the poor
What can be done when equity was not built into the design?
This presentation presents two possible analyses that MCHIP might consider during implementation
Analysis 1
What is the Socio-Economic Profile of the Beneficiaries of the Program?
See for example: Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A & Amouzou A (2007). Socio-economic differences in health, nutrition, and population: Nepal. Washington, DC: World Bank. (also includes slight variation)
Analysis 1 – Basic Steps
Step 1: Look for a recent household survey that uses an asset index as a proxy for socio-economic position
Step 2: Obtain questions used to collect the data necessary for the calculation of the asset index
Step 3: Conduct interviews using same questions
Step 4: Generate rural/urban-specific asset indices (optional)
Step 5: Create rural/urban-specific asset quintiles (optional)
Step 6: Calculate the asset index for each respondent
Step 7: Assign respondents to socio-economic quintiles
Step 8: Assess the distribution of beneficiaries across asset quintiles
Analysis 1 – Basic Steps
Step 1: Look for a recent household survey that uses an asset index as a proxy for socio-economic position
Examples:
Demographic and Health Survey (DHS)
Living Standards Measurement Survey (LSMS)
Multiple Indicator Cluster Survey (MICS)
Analysis 1 – Basic Steps
Step 2: Obtain questions used to collect the data necessary for the calculation of the asset indexExample:
Analysis 1 – Basic Steps
Step 3: Interview an adequately large sample of patients attending the facility-based service(s) of interest (exit interviews)
OR
Interview an adequately large sample of individuals/households benefitting from the community-based intervention (household visits)
Analysis 1 – Basic Steps
Step 4 (optional): Create rural/urban-specific asset quintilesSome assets may relate differently to wealth in rural and urban settings
E.g. type of flooring material; ownership of poultry
If the necessary technical expertise is available, conduct separate Principal Component Analyses for rural and urban data in the original household survey to generate rural/urban-specific asset indices
Analysis 1 – Basic Steps
Step 5 (optional): Generate rural/urban-specific asset indicesMany assets tend to be more associated with urban wealth than with rural wealth
E.g. access to basic services is overall better in urban areas than rural areas
Urban households cluster in the richer quintiles Rural households cluster in the poorer quintiles
Analysis 1 – Basic Steps
Step 5 (optional): Generate rural/urban-specific asset indicesMany assets tend to be more associated with urban wealth than with rural wealth
Poorest 2nd Middle 4th Top0%
20%
40%
60%
80%
100%
Rural Urban
Analysis 1 – Basic Steps
Step 5 (optional): Generate rural/urban-specific asset indicesMany assets tend to be more associated with urban wealth than with rural wealth
Create rural/urban-specific asset quintiles:
Using the rural/urban-specific asset indices generated under step 4 (optional)
OR
Using available country-level household asset indices
Analysis 1 – Basic Steps
Step 6: Calculate the asset index for each respondent:
Using rural/urban-specific weights calculated under step 4 (optional)
OR
Using the original survey’s weights
Analysis 1 – Basic Steps
Step 6: Calculate the asset index for each respondent:
Example:
… … …
Analysis 1 – Basic Steps
Step 7: Assign respondents to socio-economic quintiles:
Using rural/urban-specific cut-off points calculated under step 4 (optional)
OR
Using the original survey’s cut-off points
Analysis 1 – Basic Steps
Step 7: Assign respondents to socio-economic quintiles:
Example:
Analysis 1 – Basic Steps
Step 8: Assess the distribution of beneficiaries across asset quintilesExample:
Poorest 2nd Middle 4th Top0%
10%20%30%40%
Pro-poor Neutral Not pro-poor
Under what conditions can Analysis 1 be adopted?
Availability of a recent DHS, LSMS, MICS or other household survey collecting information on asset ownership, access to basic services and dwelling characteristics
Intervention supported by MCHIP is facility-based and it is possible to conduct exit interviews ORIntervention supported by MCHIP is community-based and it is possible to conduct household interviews
Analysis 2
Are Program Resources Reaching the Poorest Geographic Areas
Analysis 2 – Basic Steps
20
Step 1: Look for a recent poverty map of the country
(these typically include poverty headcount ratios by region/district/…: i.e. % of the population living below the poverty line)
Example: Coulombe H. 2005, Ghana census-based poverty map: district and sub-district level results. Ghana Statistical Service. The estimates relate to the year 2000.
Analysis 2 – Basic Steps
21
Step 2: Indicate areas of intervention on poverty map
Example: Vietnam poverty map
Analysis 2 – Basic Steps
District Population
Program Resources Allocated
Program Resources Allocated Per Capita
Poverty Headcount
Ratio
Jomoro 110,972 174,226 1.57 0.491
Nzema East 142,523 89,789 0.63 0.446
Ahanta West 94,826 146,980 1.55 0.378
Shama-Ahanta 366,215 377,201 1.03 0.264
Mpohor-Wassa 122,752 130,117 1.06 0.292
Wassa West 231,952 278,342 1.20 0.222
Wassa Amenefi 234,155 297,377 1.27 0.324
Aowin-Suaman 118,978 172,518 1.45 0.350
Juabeso-Bia 244,456 479,134 1.96 0.346
Sefwi Wiawso 149,247 211,931 1.42 0.345
… … … … …22
Step 3: Calculate resource allocation per capita by district
23
20%25%30%35%40%45%50%0.5
1
1.5
2 Juabeso-Bia
Poverty Headcount Ratio
US
$ P
er
Cap
ita
Nzema East
Analysis 2 – Basic Steps
Step 4: Plot US$ per capita against poverty headcount ratio
Under what conditions can Analysis 2 be adopted?
Availability of a recent poverty map
Intervention supported by MCHIP is targeting specific geographical areas
Thank you!
wwww.mchip.net
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