DOCSLIB.ORG

Health Equity As a Priority in the 2030 Agenda for Sustainable Development

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Health Equity As a Priority in the 2030 Agenda for Sustainable Development HEALTH EQUITY AS A PRIORITY IN THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT: A nested qualitative case study of maternal, newborn and child health in Ethiopia Nicole Bergen Thesis Supervisors: Dr. Ronald Labonté and Dr. Manisha Kulkarni Thesis submitted in partial fulfillment of the requirements for the PhD degree in Population Health Interdisciplinary School of Health Sciences Faculty of Health Sciences University of Ottawa 27 April 2020 © Nicole Bergen, Ottawa, Canada, 2020 Table of contents List of tables................................................................................................................................................. ix List of figures ................................................................................................................................................ x List of acronyms and abbreviations ............................................................................................................ xi Acknowledgements .................................................................................................................................... xii Co-authorship and approvals ..................................................................................................................... xv Abstract ..................................................................................................................................................... xvii Chapter 1. Introduction ................................................................................................................................ 1 1.1 What is health equity? ........................................................................................................................ 1 1.2 Research goals, questions and objectives........................................................................................... 5 1.3 Theoretical approach .......................................................................................................................... 6 1.3.1 Population health and social determinants of health ................................................................. 6 1.3.2 Philosophical, theoretical and conceptual framing ..................................................................... 7 1.4 Methods and methodological approach ............................................................................................. 8 1.4.1 Methodology ................................................................................................................................ 8 1.4.2 Study context ............................................................................................................................... 9 1.4.3 Data collection and analysis overview ....................................................................................... 10 1.4.4 Research participants ................................................................................................................. 12 1.5 Ethical considerations ....................................................................................................................... 15 1.6 Reflexivity statement ........................................................................................................................ 16 1.6.1 Journey to the PhD ..................................................................................................................... 16 1.6.2 Positionality and partnerships ................................................................................................... 17 1.6.3 Anticipated outcomes ................................................................................................................ 19 1.7 References ........................................................................................................................................ 19 Chapter 2. Literature review: health equity ............................................................................................... 24 2.1 Defining health equity and related terminology .............................................................................. 24 2.2 Three constructs of health equity ..................................................................................................... 26 2.2.1 Health ......................................................................................................................................... 26 2.2.2 Distribution of health ................................................................................................................. 28 2.2.3 Characterization of the distribution of health ........................................................................... 29 2.3 Approaches to reduce health inequity ............................................................................................. 30 ii 2.4 The UN 2030 Agenda for Sustainable Development ........................................................................ 32 2.4.1 A new global development agenda ........................................................................................... 32 2.4.2 The emergence of equity as a priority ....................................................................................... 35 2.4.3 Implementing the SDGs and advancing health equity ............................................................... 36 2.5 Conclusion ......................................................................................................................................... 38 2.6 References ........................................................................................................................................ 39 Chapter 3. Maternal, newborn and child health in Ethiopia ...................................................................... 48 3.1 Federal Democratic Republic of Ethiopia .......................................................................................... 48 3.1.1 Oromia region ............................................................................................................................ 50 3.1.2 Jimma Zone ................................................................................................................................ 51 3.2 Health sector ..................................................................................................................................... 53 3.2.1 Organization and financing ........................................................................................................ 53 3.2.2 National policies and programs ................................................................................................. 55 3.2.3 Community mobilization and ownership ................................................................................... 57 3.3 Maternal, newborn and child health ................................................................................................ 58 3.3.1 Historical context of health, with a focus on MNCH .................................................................. 58 3.3.2 MNCH during the MDG period: mixed success .......................................................................... 60 3.3.3 Inequities in MNCH .................................................................................................................... 61 3.4 Promoting equity in MNCH ............................................................................................................... 63 3.4.1 Health equity and the Health Extension Program ..................................................................... 64 3.4.2 Health equity and MWAs ........................................................................................................... 66 3.5 Moving forward an agenda for equity in MNCH? ............................................................................. 70 3.6 Conclusion ......................................................................................................................................... 71 3.7 References ........................................................................................................................................ 72 Chapter 4. Exploring health and health inequality among rural communities in Jimma Zone .................. 84 4.1 Abstract ............................................................................................................................................. 85 4.2 Keywords ........................................................................................................................................... 86 4.3 Background ....................................................................................................................................... 86 4.4 Methods ............................................................................................................................................ 87 4.4.1 Sampling and participant recruitment ....................................................................................... 87 4.4.2 Data collection ........................................................................................................................... 88 4.4.3 Data analysis .............................................................................................................................. 88 4.4.4 Ethical clearance ........................................................................................................................ 89 iii 4.5 Results ..............................................................................................................................................
Load more

Recommended publications
  • Kerchanshe Trading Plc Addis Ababa,St Gabriel Church Bayne Building, Addis Ababa/ N/S/ Lafto, Ethiopia
    SCS Global Services does hereby certify that an independent assessment has been conducted of: Kerchanshe Trading Plc Addis Ababa,St Gabriel church Bayne Building, Addis Ababa/ N/S/ Lafto, Ethiopia Scope of Certificate: Organic Coffee Arabica Washed and Organic Coffee Arabica Natural (organic green coffee) At the following sites: See Annex The facilities are hereby certified to sell products as: Fair Trade Certified The assessment has been conducted by SCS Global Services (SCS) in accordance with the standards and compliance criteria listed below: Fair Trade USA Agricultural Production Standard - Version 1.1.0 Fair Trade USA ID#: 1661106 Valid from 21 July 2020 to 20 July 2023 Jim Knutzon, Vice President SCS Global Services 2000 Powell Street, Ste. 600, Emeryville, CA 94608 USA This is an addendum to certificate #1661106 and must be accompanied by this certificate to be considered valid. This addendum is not a certificate and is not valid as a stand-alone document. Kerchanshe Trading Plc Addis Ababa,St Gabriel church Bayne Building, Addis Ababa/ N/S/ Lafto, Ethiopia Fair Trade USA ID #: 1661106 . Name Address Product Form Beshasha Limmu wet and dry mill Oromia Region, Jimma Zone, Organic Coffee Arabica Washed and Organic Coffee Arabica Gomma Woreda, Bashasha, Natural (organic green coffee) Ethiopia Kochere wet and dry mill SNNPRS, Gedio Zone, Kochore Organic Coffee Arabica Washed and Organic Coffee Arabica Woreda , Kochore, Ethiopia Natural (organic green coffee) Guji Adola wet and dry mill Oromia, Region, Guji Zone, Organic Coffee Arabica
    [Show full text]
  • Who-Is-PM-Abiy-Ahmed-Final-Draft
    Who is Prime Minister Abiy Ahmed Ali? By: Achamyeleh Tamiru1 Introduction This article raises some serious questions on the integrity and honesty of the current Ethiopian Prime minister Abiy Ahmed Ali. As a Bible thumping leader, Abiy Ahmed needs to come clean about so many questions in his checkered biography. Whether we agree with him on his current actions (inactions) and policies and his flamboyant camera seeking styles, it is important we question the integrity of the man who is at the helm of a country we all love. Source & Authenticity The Wikipedia post of the biography PM Abiy Ahmed is written by the PM himself. This is a fact verified by a credible source close to the prime ministers office. On the other hand, if a person wishes to remove the post or to correct it he or she has the right. But if the stories entered were wrong, the PM or his office would have removed or corrected it. Early life Abiy Ahmed was born in the town of Beshasha[9] in the historic Kaffa Province (in the present day Jimma Zone, Oromia Region), Ethiopia on 15 August 1976.[10][11] His father, Ahmed Ali, was a MuslimOromo[12] (and had four wives[13]), while his mother, Tezeta Wolde,[14]) was an Orthodox[15] Christian.[16][17] Abiy is the 13th child of his father and the sixth and youngest child of his mother.[9][16] His childhood name was Abiyot (English: "Revolution"). The name was sometimes given to children in the aftermath of the Derg revolution of 1974.[9] The then Abiyot went to the local primary school 1 Achamyeleh Tamiru is an Independent writer, Commentator (Ethiopian Affairs), Economic Researcher, Analyst and former lecturer.
    [Show full text]
  • Who Is Abiy Ahmed Ali (Phd)?
    Who is Abiy Ahmed Ali (PhD)? Who is Abiy Ahmed Ali (PhD) ? Abiy Ahmed (PhD), Prime Minister of Ethiopia Abiy Ahmed Ali (Ge’ez: ዐቢይ አህመድ አሊ; born 15 August 1976) is an Ethiopian politician serving as 4th Prime Minister of Ethiopia of the Federal Democratic Republic of Ethiopia since 2 April 2018. He is the first Oromo chairman of the ruling Ethiopian People’s Revolutionary Democratic Front (EPRDF) from the Oromo Democratic Party (ODP), which is one of the four coalition parties of the EPRDF. Abiy is also an elected member of the Ethiopian parliament, and a member of the ODP and EPRDF executive committees. A former army intelligence officer, since becoming Prime Minister Abiy has launched a wide programme of political and economic reforms, and worked to broker peace deals in Eritrea, South Sudan, and a transition agreement in the Republic of the Sudan. Abiy was awarded the 2019 Nobel Peace Prize for his work in ending the 20-year post-war territorial stalemate between Ethiopia and Eritrea. Abiy Ahmed was born in the small town of Beshasha, located near Agaro, Oromia. His deceased father, Ahmed Ali, was a Muslim Oromo (and had four wives), while his deceased mother, Tezeta Wolde, was a Christian Oromo. Despite some sources claims that his mother was an ethnic Amhara, Dr. Abiy witnessed on Oromia Broadcasting Network interview said that both of his parents are Oromo and asserted no one is given and taken away my Oromummaa. Abiy’s Father was a typical Ethiopian farmer and was only able to speak Afaan Oromo while Mrs.
    [Show full text]
  • Daffis Abafita Oromia, Jimma Zone, Goma Woreda, Ethiopia
    Daffis Abafita Oromia, Jimma Zone, Goma Woreda, Ethiopia Partner since: 2019 Traceable to: Single Farm Altitude: 2050 MASL Varietals: Heirloom, 74110, Processing: Dafis harvests and 74165 processes cherries from his own farm. Raised bed drying takes 15-17 days, before primary milling to remove the dry husks in nearby Beshasha. Harvest: October November December Booking: March April May Arrivals: May June July Dafis operates his own farm, and does not buy from outgrowers/neighbors. 90% of his harvest grades out to bean size at or above screen 14, which points to the special care he puts into picking at peak ripeness. Here in Beshasha, Dafis grew up farming coffee with his siblings and parents, and has lived here all his life. For most of the years managing his own farm he sold to one of the local Kata Muduga cooperatives, however, his history and knowledge in coffee farming and processing led him to step out on his own. In 2019 he began to export under his own license, and the positive results of this passion for coffee can be seen in the cup. Beshasha, itself, is a famed town in Ethiopia, as it is one of the cultural and political centers of the Oromo region and culture. When growing up here, Dafis stayed back to support his family farm while a few others in his family went on to attend high school. His brother, Abiy Ahmed went on to be elected Prime Minister of Ethiopia in 2018, soon followed by the Nobel Peace Prize. Together, these two brothers represent not only a major victory for regional peace, but also a stake in the ground for Beshasha, the larger Agaro and Jimma regions and its central economic pride – coffee.
    [Show full text]
  • Spatial Variability in Factors Influencing
    Kurji et al. BMC Health Services Research (2021) 21:454 https://doi.org/10.1186/s12913-021-06379-3 RESEARCH ARTICLE Open Access Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis Jaameeta Kurji1*, Charles Thickstun1, Gebeyehu Bulcha2, Monica Taljaard3, Ziqi Li4 and Manisha A. Kulkarni1 Abstract Background: Persisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub- national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia. Methods: Cross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women’s proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality. Results: Significant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women’s decision-making involvement (p = 0.124).
    [Show full text]
  • Dafis Abafita Oromia, Jimma Zone, Goma Woreda, Ethiopia
    Dafis Abafita Oromia, Jimma Zone, Goma Woreda, Ethiopia Partner since: 2019 Traceable to: Single Farm Altitude: Varietals: Heirloom, 74110, Processing: Dafis harvests and 74165 processes cherries from his own farm. Raised bed drying takes 15-17 days, before primary milling to remove the dry husks in nearby Beshasha. Harvest: October November December Booking: March April May Arrivals: May June July Community Context Dafis operates his own farm, and does not buy from outgrowers/neighbors. 90% of his harvest Page 1/4 grades out to bean size at or above screen 14, which points to the special care he puts into picking at peak ripeness. Here in Beshasha, Dafis grew up farming coffee with his siblings and parents, and has lived here all his life. For most of the years managing his own farm he sold to one of the local Kata Muduga cooperatives, however, his history and knowledge in coffee farming and processing led him to step out on his own. In 2019 he began to export under his own license, and the positive results of this passion for coffee can be seen in the cup. Beshasha, itself, is a famed town in Ethiopia, as it is one of the cultural and political centers of the Oromo region and culture. When growing up here, Dafis stayed back to support his family farm while a few others in his family went on to attend high school. His brother, Abiy Ahmed went on to be elected Prime Minister of Ethiopia in 2018, soon followed by the Nobel Peace Prize. Together, these two brothers represent not only a major victory for regional peace, but also a stake in the ground for Beshasha, the larger Agaro and Jimma regions and its central economic pride – coffee.
    [Show full text]
  • Characterization of Village Chicken Production and Marketing System in Gomma Wereda, Jimma Zone, Ethiopia
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CGSpace CHARACTERIZATION OF VILLAGE CHICKEN PRODUCTION AND MARKETING SYSTEM IN GOMMA WEREDA, JIMMA ZONE, ETHIOPIA M.Sc. Thesis MESERET MOLLA BOGALLE JIMMA UNIVERSITY, ETHIOPIA August, 2010 JIMMA UNIVERSITY CHARACTERIZATION OF VILLAGE CHICKEN PRODUCTION AND MARKETING SYSTEM IN GOMMA WEREDA, JIMMA ZONE, ETHIOPIA Meseret Molla Bogalle Thesis Submitted to the Department of Animal Science, Jimma University, College of Agriculture and Veterinary Medicine, School of Graduate Studies Jimma, Ethiopia In Partial Fulfillment of the Requirements for the Degree of Master of Science in Animal Sciences (Specialization: Animal Production) August, 2010 Jimma University ii APPROVAL SHEET School of Graduate Studies As thesis research advisor, we hereby certify that we have read and evaluated this thesis prepared, under our guidance, by Meseret Molla Bogalle entitled: Characterization of Village Poultry Production and Marketing System in Gomma Wereda, Jimma Zone, Ethiopia. We recommend that it be submitted as fulfilling thesis requirement. Solomon Demeke (Prof.) ---------------------------- -------------------- Major Advisor Signature Date Tadelle Dessie (PhD) ------------------------------- ------------------- Co-Advisor Signature Date As member of Board of Examiners of the M.Sc. Thesis Open Defense Examination, We certify that we have read, evaluated the thesis prepared by Meseret Molla Bogalle and examined the candidate. We recommended that the thesis could be accepted as fulfilling the thesis requirement for the Degree of Master of Science in Animal Production. _________________ _________________ ______________ Chair person Signature Date _________________ _________________ ______________ Internal Examiner Signature Date ___________________ ________________ _____________ External Examiner Signature Date iii DEDICATION I dedicate this manuscript to my father Ato Molla Bogalle, who passed away without seeing any of my achievements.
    [Show full text]
  • Maternal and Child Health in Jimma Zone, Ethiopia: Predictors, Barriers and Strategies for Improvement
    Maternal and Child Health in Jimma Zone, Ethiopia: Predictors, Barriers and Strategies for Improvement Mariame Oumar Ouedraogo A thesis submitted to the Faculty of Graduate and Postdoctoral Studies in partial fulfillment of the requirements for the MSc degree in Epidemiology School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Mariame Oumar Ouedraogo, Ottawa, Canada, 2018 Table of Contents Table of Contents .......................................................................................................................... ii Acknowledgements ........................................................................................................................ iv Abstract .......................................................................................................................................... vi List of Tables ............................................................................................................................... viii List of Figures ................................................................................................................................ xi List of Abbreviations .................................................................................................................. xiii Chapter 1: General Introduction .................................................................................................. 1 Global Status of Maternal and Child Health .......................................................................................
    [Show full text]
  • Assessing the Determinants of Maternal Healthcare Service Utilization and Effectiveness of Interventions to Improve Institutional Births in Jimma Zone, Ethiopia
    Assessing the determinants of maternal healthcare service utilization and effectiveness of interventions to improve institutional births in Jimma Zone, Ethiopia Jaameeta Kurji Thesis submitted to the University of Ottawa in partial fulfillment of the requirements for a Doctorate of Philosophy degree in Epidemiology School of Epidemiology and Public Health Faculty of Medicine University of Ottawa © Jaameeta Kurji, Ottawa, Canada, 2021 Table of Contents List of tables iv List of figures v Abbreviations vii Abstract viii Acknowledgements ix Preface x 1 Introduction 1.1 Organization of the thesis 1 1.2 Conceptual framework and objectives 3 1.3 Trends in maternal mortality 8 1.4 Safe motherhood and global commitments 11 1.5 Maternal mortality and access to maternal healthcare 13 1.6 Access to care and service utilization 13 2 Background 2.1 Overview of the healthcare system in Ethiopia 19 2.2 Definitions of maternal healthcare services 24 2.3 Status of maternal healthcare service use in Ethiopia 26 2.4 Factors influencing maternal healthcare service use 32 2.5 Maternity waiting homes 40 2.6 Role of community and religious leaders in maternal healthcare service use 52 3 Methods 3.1 Study setting 68 3.2 Evaluation of complex interventions 72 3.3 Sample size calculations for the cluster-randomized control trial 73 3.4 Household survey questionnaire design and data collection 76 3.5 Random selection of eligible women 78 3.6 The MWH+ intervention component 79 3.7 Spatial analytic methods 88 Trial analyses 97 4 What factors influence whether or
    [Show full text]
  • Prevalence of Some Coffee Quality Problems in Gomma Woreda, Jimma Zone
    International Journal of Agricultural Sciences ISSN: 2167-0447 Vol. 3 (8), pp. 621-627, October, 2013. Available online at www.internationalscholarsjournals.org © International Scholars Journals Full Length Research Paper Prevalence of some coffee quality problems in Gomma Woreda, Jimma Zone Techale B1, Musema A2 and Kasahun M3 1,2,3Department of Horticulture and Plant Science, Jimma University College of Agriculture and Veterinary Medicine, Jimma, P.O.BOX-307, Ethiopia. Accepted 09 September, 2013 Despite the favorable climatic condition and long history of coffee production in Gomma Woreda, quality of coffee is declining due to poor pre and post harvest practices. Therefore; a study was conducted to assess the prevalence of some pre-identified coffee quality problems in the Woreda in 2013. For quantitative analysis respondents were drawn and data were collected from 150 households. The result indicated that majority of the respondents were headed by males (83%) with large family size (73%). In addition to that, most of the respondents (83.33%) owned old coffee trees (>20 years). The analysis on the pruning practice, harvesting stage, coffee storage method also showed that 93.3% of the respondents practice pruning and 100% of the respondents harvest coffee at full maturity stage but 80% of the respondents mix differently harvested coffee during storage and selling. From this finding we can conclude that institutional factors like age and educational status are found to be the major problems whereas, family size and household head has average effects on coffee quality. Moreover; pre and post harvest practices like age of coffee, disease and weed, compost application and mixing differently harvested coffee had significant effect on quality of coffee in the study area.
    [Show full text]
  • Uncovering Spatial Variation in Maternal Healthcare Service Use At
    Kurji et al. BMC Health Services Research (2020) 20:703 https://doi.org/10.1186/s12913-020-05572-0 RESEARCH ARTICLE Open Access Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia Jaameeta Kurji1* , Benoit Talbot1, Gebeyehu Bulcha2, Kunuz Haji Bedru2, Sudhakar Morankar3, Lakew Abebe Gebretsadik3, Muluemebet Abera Wordofa4, Vivian Welch5, Ronald Labonte1 and Manisha A. Kulkarni1 Abstract Background: Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with household wealth and women’s education levels were also assessed. Methods: Using survey data from 3758 households enrolled in a cluster randomized trial geographical variation in the use of maternity waiting homes (MWH), antenatal care (ANC), delivery care and postnatal care (PNC) was investigated in three districts in Jimma Zone. Correlations of service use with education and wealth levels were also explored among 24 health centre catchment areas using choropleth maps. Global spatial autocorrelation was assessed using Moran’s I. Cluster analyses were performed at village and household levels using Getis Ord Gi* and Kulldorf spatial scan statistics to identify cluster locations. Results: Significant global spatial autocorrelation was present in ANC use (Moran’s I = 0.15, p value = 0.025), delivery care (Moran’s I = 0.17, p value = 0.01) and PNC use (Moran’s I = 0.31, p value < 0.01), but not MWH use (Moran’sI=- 0.005, p value = 0.94) suggesting clustering of villages with similarly high (hot spots) and/or low (cold spots) service use.
    [Show full text]
  • Prevalence of Some Coffee Quality Problems in Gomma Woreda, Jimma Zone
    World Applied Sciences Journal 29 (2): 202-207, 2014 ISSN 1818-4952 © IDOSI Publications, 2014 DOI: 10.5829/idosi.wasj.2014.29.02.1408 Prevalence of Some Coffee Quality Problems in Gomma Woreda, Jimma Zone Techale Birhan, A. Musema and M. Kasahun Department of Horticulture and Plant Science, Jimma University College of Agriculture and Veterinary Medicine, Jimma, Ethiopia Abstract: Despite the favorable climatic conditions, variety of coffee types and long history of coffee production in Jimma Zone, Gomma Woreda, quality of coffee is poor due to traditional poor pre and post harvest practices. Therefore; a study was conducted to assess the occurrence of some of coffee quality problems in the woreda, in 2013. For quantitative analysis participant respondents were drawn and cross sectional survey data were collected from 30 households. The result indicated that majority of coffee farmers households were headed by males (83%) with large family size (73%). In addition to that, most of the respondents (83.33%) owned old coffee trees (>20 years). The analysis on the pruning practice, harvesting stage, coffee storage method also showed that 93.3% of the respondents practice pruning and 100% of the respondents harvest coffee at full maturity stage but 80% of the respondents mix differently harvested coffee during storage and selling. From the study we can conclude that institutional factors like age and educational status are found to be major problem whereas, sex and head household has little effects on coffee quality. Moreover; pre-harvest and post harvest practices like age of coffee, disease and weed prevention, compost application, storage condition and storage time have significant effect on quality of coffee.
    [Show full text]