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Monitoring health equity for social marketing programs in Nepal

Monitoring health equity for social marketing programs in Nepal. Rebecca Firestone, Nirali Chakraborty , Mahesh Paudel , Nicole Bellows 9 th World Congress on Health Economics 7-10 July 2013 Contact: rfirestone@psi.org. Background + Objectives. Nepal

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Monitoring health equity for social marketing programs in Nepal

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  1. Monitoring health equity for social marketing programs in Nepal Rebecca Firestone, NiraliChakraborty, Mahesh Paudel, Nicole Bellows 9th World Congress on Health Economics 7-10 July 2013 Contact: rfirestone@psi.org

  2. Background + Objectives Nepal Under-5 mortality 48/1,000 live births Maternal mortality 170/100,000 live births How do we know that programs are reaching target populations equitably? Implementers need reliable and actionable measures of equity in program performance. We aim to: Estimate socio-economic distributions of health outcomes from survey data using an SES measure benchmarked against a national reference population Estimate socio-economic distributions of programmatic exposure Disaggregate outcomes by exposure level PSI implements malaria prevention and family planning in Nepal using social marketing strategies Data sources: UNICEF, World Bank

  3. Methods • Data • Population-representative 2011 survey of 1078 households on family planning in 23 districts where PSI operates, measuring • Modern contraceptive use • Exposure to any IUD messages, to PSI-branded communications on IUDs • Population-representative 2010 survey of 3327 households on malaria prevention in 13 districts where PSI operates, measuring • Any bednet and any LLIN use (children <5, pregnant women) • Exposure to PSI-branded communications on LLINs, home visit on LLIN use • Analysis • Wealth index constructed using asset values – means, standard deviations, PCA weights – from 2011 Nepal DHS • Wealth quintiles and concentration indices calculated for all measures • Significance testing • Chi-square test for equality of proportions for quintile estimates • 95% CI for each quintile • Standard errors of concentration indices to test H0 • T-test differences in means to compare concentration indices exposed and unexposed

  4. Modern Contraceptive Use and Exposure to Communications by National Wealth Distribution CI PSI= 0.056* CI DHS = 0.055* n=1036 CI Unexposed = 0.004 CI Exposed = 0.015 41% of women exposed, H0: CIexposed=CIunexposedp=0.686 CI Unexposed = 0.071* CI Exposed = 0.006 54% of women exposed, H0: CIexposed=CIunexposedp=0.026 * statistically significant at p<0.05; CI = concentration index

  5. Malaria Prevention Outcomes and Exposure to Communications for Children < 5 (n=1805) by National Wealth Distribution CI under LLIN= -0.035* CI under any net= 0.012* CI Unexposed = -0.0.129* CI Exposed = -0.049* 67% of children exposed, H0: CIexposed=CIunexposedp<0.001 CI Unexposed = -0.051* CI Exposed = -0.022* 30% of children, H0: CIexposed=CIunexposedp=0.188 * statistically significant at p<0.05; CI = concentration index

  6. Findings and Recommendations Distribution of LLINs favored the poor among children <5. For any bednet use and contraceptive use, the wealthy fared slightly better Population in areas where PSIS operates had higher levels of contraceptive use than DHS, but comparable level of equity All outcomes tended to be more equitably distributed among those exposed compared to unexposed Social marketing programs can reach the poor and contribute to equitable health outcomes Equity monitoring can be used to adjust implementation strategies to ensure programs are reaching target populations as intended Further reading at http://www.biomedcentral.com/1471-2458/13/S2/S6

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