Among the global health community, a common challenge is determining whether programs are reaching target communities, frequently those in poorer households. This information allows program managers to adjust and improve service delivery. But they need data and real-time feedback. Conventional approaches to evaluation can provide some of this information, but often with significant delays and at great expense.
The need for a simple approach to equity assessment led to the birth of the EquityTool. It assesses the wealth of program beneficiaries in more than 65 low- and middle-income countries, and was developed by experts from Metrics for Management (M4M); USAID; UNICEF; Population Services International (PSI); MSI Reproductive Choices; Results for Development; University of California, San Francisco; and Broad Branch Associates.
“The tool, we thought, was excellent. Rigorously developed based on expert input, it was a big improvement on existing wealth assessment methods. Using EpiInfo, it simplified the data analysis and offered video guidance,” said Dominic Montagu, M4M’s Chief Executive Officer.
The data tool, EpiInfo, is commonly used by epidemiologists but requires advanced statistical knowledge, making it too complex for most program staff to administer. It also asked questions that clients were unlikely to know the answers to, such as how many hectares of land their family owns.
Gathering program managers, economists, researchers, and nonprofit leaders, the project team, led by Dr. Nirali Chakraborty, developed four different approaches to simplify the survey, such as removing questions that could only be verified if you were at the respondent’s home. When none of the options satisfied end-users, the team regrouped and rethought their approach.
“Our work on this tool was M4M’s first deep dive into human-centered design, with a plotline of empathy, definition, ideation, prototyping and testing. We didn’t succeed until we connected to the actual people who would use the tool. This was the critical missing link,” said Dr. Montagu.
A constant work-in-progress
The EquityTool continues to evolve. Today, the tool is primarily based on the wealth indices generated from Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). The country-specific questionnaires average 12 easy-to-answer questions, and results can be automatically calculated, allowing comparison of the wealth of respondents to the national or urban population. With easy-to-use data collection methods that can be adapted to any platform, the tool tells you what percentage of your respondents are in each wealth quintile, so you can see whether you’re serving the relatively rich or the relatively poor.
The EquityTool is updated as new DHS, MICS or other nationally representative household surveys containing asset ownership questions become available.
Helping reach those with the greatest need
In Bangladesh, the EquityTool helped the United Nations Children’s Fund (UNICEF) to increase the useability and representativeness of data collected via U-Report, UNICEF’s mobile-based tool where young people share opinions and information.
U-Report has more than 11 million users in 68 countries who respond to polls, report issues and support child rights. While U-Report was viewed as a credible platform for collecting and sending information, its data was not sufficiently representative to allow statistical analysis.
When the UNICEF Bangladesh team added an EquityTool survey to the platform in 2018, it enabled real-time wealth assessment of more than 56,000 users – revealing 79% of respondents came from the two wealthiest quintiles, with just 21% from the three lowest quintiles. UNICEF concluded that the EquityTool integration enhanced the quality of crowdsourced data for statistical analysis and application, and that using the tool gave them a better understanding of population needs.
In Benin and Côte d’Ivoire, the EquityTool played an important role in the monitoring of equity in the delivery of a sanitation project.
Implemented by PSI between 2014 and 2021, the project began using the EquityTool in 2018 to monitor the distribution of beneficiaries relative to published country wealth quintiles. With the need to assess wealth profiles across multiple communities in two different countries, the project required easily adaptable questionnaires and data collection methods.
Understanding the wealth profiles of existing project clients provided the team with an opportunity to evaluate project goals, and provided input on how the timing of wealth assessment could be altered for future projects, to effectively target populations in specific wealth quintiles.
The EquityTool has strong research behind it, focuses on the needs of users, and makes data collection and analysis easy – and that enables programs to strengthen the services they provide to those most in need.
Learn more about EquityTool and how it can help your organization improve health outcomes.
Written by Andrea Sprockett, Chief Operating Officer, Metrics for Management
DISCLAIMER: The views, thoughts, and opinions expressed in this guest blog post belong solely to the author and do not necessarily represent those of the Global Digital Health Network.