Measurement of Health Program Equity Made Easier: Validation of a Simplified Asset Index Using Program Data From
Alex Ergo1, Julie Ritter2, Davidson R Gwatkin3
1Broad Branch Associates, Washington, DC, USA.
Global Health, Science and Practice
|March 27, 2016
Summary
Simplifying wealth assessment for health programs is feasible. Researchers can use fewer questions to accurately evaluate pro-poor interventions without compromising policy conclusions, making equity assessments more routine.
Area of Science:
- Health Services Research
- Health Economics
- Development Economics
Background:
- Equitable access to health services is crucial for global health goals but rarely measured due to complex wealth assessment.
- Traditional asset or wealth indices require numerous survey questions, hindering routine evaluation.
Purpose of the Study:
- To determine if a reduced set of variables and questions can accurately assess wealth quintiles for program evaluation.
- To assess if simplification compromises programmatic conclusions regarding equity.
Main Methods:
- Utilized data from program evaluations in Honduras and Senegal, using full Demographic and Health Survey (DHS) asset questionnaires as a gold standard.
- Applied Principal Components Analysis to identify key variables and Cohen's kappa statistic to measure agreement after reducing variable sets.
Main Results:
- In Honduras, 41 questions were reduced to 8, maintaining wealth distribution and policy conclusions (kappa=0.634).
- In Senegal, 36 questions were reduced to 20, preserving user distribution in lower quintiles (kappa=0.882).
- Asset variables contributing to indices showed minimal overlap between countries.
Conclusions:
- Substantially reducing asset index variables and questions is feasible for valid, less burdensome equity assessments.
- Simplified indices can help evaluate if interventions are pro-poor.
- A standardized, simplified global questionnaire may be challenging due to country-specific asset relevance.
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