Sightsavers Catch Program Uses the EquityTool
Sightsavers researchers compare EquityTool with other asset-based wealth assessment tools to identify a practical solution for field-based vision care project targeting
BACKGROUND
Malawi is one of the poorest countries in the world, with more than 50% of the population living below the national poverty line, and 25% living in extreme poverty. As a result, many Malawians face challenges in accessing health care—access that is even more difficult for poor people to achieve because they often experience other disadvantages, such as gender inequalities or disability, in addition to poverty. Sightsavers served Malawians in need of vision care through the Coordinated Approach To Community Health (CATCH) program, an integrated eye health program funded by the UK Foreign, Commonwealth and Development Office (formerly the Department for International Development), to increase the coverage of eye health services in trachoma-endemic areas of Eastern and Southern Africa. CATCH intended to reduce health disparities by reaching those with the greatest need, including people in remote and rural locations, those living with disabilities, and those with low incomes compared to others in their communities and to the national poverty line.
CHALLENGE: ENSURING THAT SERVICES REACH TARGETÂ RECIPIENT GROUPS
Was CATCH succeeding in reaching the right people with interventions? To answer this, the program needed to understand the sociodemographic and socioeconomic profiles of CATCH participants. Even in the most remote areas, it is possible that health programs reach only individuals who are comparatively advantaged and fail to meet the needs of the most underserved community members.
But it can be time consuming and expensive to collect community and household wealth information, particularly in low- and middle-income countries where in-kind payments make up a significant proportion of income, and income often fluctuates according to seasonality and migration. This makes it difficult to routinely collect information that should be available to inform planning and ongoing program implementation. Sightsavers needed to identify a practical, easy-to-use, and reliable tool that allowed program staff to regularly assess relative wealth in program participants. Between April and September 2017, Sightsavers implemented a descriptive cross-sectional survey to test multiple wealth assessment tools in Kasungu district, Central Malawi. As well as assessing the disability status of individuals, the relative and absolute wealth of CATCH camp participants was measured. The study involved collecting and analyzing data from patients at monthly CATCH eye camps to assess equity of access to the camps’ eye care services, and identifying if CATCH was reaching their target recipients: individuals from the most economically disadvantaged backgrounds, those with disabilities, and women.
OBJECTIVES:
Sightsavers researchers defined three objectives:
- Validate self-reported household characteristics;
- Compare CATCH beneficiaries’ socioeconomic status with the rest of the district population;
- Determine how reliable and effective the EquityTool and Simple Poverty Scorecard are for collecting routine data on economic status of program beneficiaries.
The study was undertaken with a goal of identifying data that could help guide the program’s community mobilization and awareness raising campaigns, ultimately ensuring that the program reached those in greatest need and left no one in the community behind.
SOLUTION: IDENTIFYING A PRACTICAL, RELIABLE WEALTHÂ ASSESSMENT TOOL
The EquityTool is a simple and easy-to-use tool that allows users to measure relative wealth by comparing the wealth of respondents to the national or urban-only population of the country. It provides a short set of questions that can be incorporated into any survey platform and is free to use. The short set of questions facilitates easy, quick, and inexpensive data collection and analysis of wealth distribution. This allows for fast and accurate comparisons across programs and populations into five wealth quintiles (quintile 1 is the poorest, quintile 5 the wealthiest). EquityTool data lets users make near real-time adjustments in program delivery that increase organizational effectiveness and strengthen program outcomes.
The short EquityTool survey, which can be completed in a few minutes, measures household wealth based on country-specific questions that are adjusted to the context. It is available for over 65 countries and survey questions are pre-translated into local languages. Each country-specific EquityTool questionnaire identifies what percentage of respondents are in each national or urban wealth quintile, and supplies the appropriate statistical code and assessment instructions for analysis. Compatible with any data collection platform – even paper-based systems – the EquityTool requires only six to 18 questions from the DHS Wealth Index for a respondent’s country, reducing the number of variables needed for accurate wealth assessment.
Sightsavers researchers tested the EquityTool, as well as a second asset-based tool, the Simple Poverty Scorecard (SPS), as potential solutions for ongoing, practical wealth assessment. (The project also employed the Washington Group Short Set of Questions on Disability, though this was not explored in the current case study.) CATCH participant responses were collected at CATCH camp locations, then follow-up household visits were conducted to check the validity of self-reported household characteristics.
Next Steps
This study confirmed for Sightsavers that it is possible to assess the wealth of their program participants in an accessible, inexpensive, and reliable way, that lends itself to routine wealth measurement. By generating valuable evidence on the associations between disability, wealth and other sociodemographic factors, this study provides valuable evidence for health interventions in low- and middle income countries.
As a result of their experience with the EquityTool in the CATCH project, Sightsavers has expanded their use of real-time wealth assessment across other projects and will continue to look for opportunities to use the tool to assess relative wealth.
M4M can help you use the EquityTool in your project. For more information, contact partnerships@m4mgmt.org.
