Equity analysis for RMNCAH/N

Sida is planning a second phase of the RMNCAH/N Health programme on reproductive, maternal, newborn, Child, adolescent health and nutrition in Zambia 2015-2019, extended up to June 2020 and with a planned additional extension up to December 2020 adjusting to COVID-19. A new programme is expected to start during the first half of 2021. The next phase will be assessed during the autumn of 2020 and will be a follow-up to Phase I but with a stronger focus on supporting high impact interventions and systems strengthening to ensure continued progress to reduce maternal and newborn deaths and the high number of teenage pregnancies and malnourished children. Community Health and adolescent SRHR will be further enhanced. In line with this and to ensure that appropriate data is available for the right type and direction of interventions, it is proposed to conduct an analysis of the recent Demographic Halth Survey 2018, DHS, from a more systematic Equity perspective. During the spring of 2019, a Mid-Term Review of the RMNCAH/N programme was conducted by Sida's Health and SRHR framework agreement consultancy firm KIT. Oe major take-away from the MTR findings was that Sida needs to better address and programme interventions and activities from an Equity perspective. This includes improved targeting based on inequities stemming from socio-economic, gender, geographic, age-related factors. The Ministry of Health has also requested more in-depth analysis to identify pockets of inequities in service provision and quality of care across the country. When the RMNCAH/N programme Phase I focused on more generalized interventions to improve service delivery, it has been assessed that it is now critical to support tailor-make interventions based on more individual capacities, contexts and needs in various districts in the provinces supported. In 2019, WHO African regional office and Zambia's Ministry of Health published a report on Health Equity and Social Determinants of Health in Zambia to gather evidence to support a comprehensive policy move towards Universal Health Coverage in Zambia. The Zambian Government is committed to fulfil its aim to reach the SDGs Before 2030 and to "leave no one behind" - a phrase which is often heard in various policy and health-decision making fora. The Embassy has contacted the School of Public Health at the University of Zambia, SoPH, as they have been responsible for conducting a recent study of the DHS 2013/14 from a Health inequality perspective earlier in 2019, based on the WHO study. A dissemination of results took place in August 2019. As the Embassy started planning Phase II of the Health programme, SoPH were approached to consider repeating a similar study on the DHS 2018 to ensure analysis of recent data. The preliminary DHS 2018 was launched in October 2019 and the final study was published in February 2020. The Equity analysis will estimate national and provincial level RMNCHA&N health indicators and intervention coverage levels, and examine rural-urban, gender, age and socioeconomic inequalities over the period 2014—2019 , and explore availability, accessibility, acceptability and quality of care of RMNCAH&N services in selected districts in the Sida-funded provinces in Zambia. The Equity analysis will have two phases: 1. Quantitative focus: Data Collection and selection of appropriate indicators to be measured. Analysis of national, provincial and district trends in indicators. Modelling of the factors that could explain inequities. Report ready by August 2020. 2. Qualitiative focus: Barriers and facilitators to availability, accessibility and acceptability of RMNCHA/N interventions. Final report ready by March 2021. Focus on the questions how and why. Phase 1-2 will provide a solid backbone for formulating the new programme on RMNCAH/N Phase II and provide input for detailed targeting of districts during the Inception phase of RMNCAH/N Phase II.