Health Inequality Monitoring: with a special focus on low- and middle-income countries

The World Health Organization developed the Handbook on health inequality monitoring: with a special focus on low- and middle-income countries to provide an overview for health inequality monitoring within low- and middle-income countries, and act as a resource for those involved in spearheading, improving or sustaining monitoring systems. The handbook was principally designed to be used by technical staff of ministries of health to build capacity for health inequality monitoring in World Health Organization Member States; however, it may also be of interest to public health professionals, researchers, students and others. We assume that the users of this handbook have basic statistical knowledge and some familiarity with monitoring related issues. The aim of this handbook is to serve as a comprehensive resource to clarify the concepts associated with health inequality monitoring, illustrate the process through examples and promote the integration of health inequality monitoring within health information systems of low- and middle-income countries.

The early conceptualization of this handbook was informed by previous experiences working with ministries of health staff in low- and middle-income countries to develop competencies in health inequality monitoring. These experiences included developing and delivering training courses and modules and facilitating training workshops. This provided a foundation for the general approach of the handbook: to introduce and elaborate upon the stages of health inequality monitoring with a sustained focus on practical and useful applications of concepts at the country level.

The handbook presents the background and process of health inequality monitoring in five sections. The first section provides an overview of the health inequality monitoring process and its implications, and highlights considerations that underlie the selection of health indicators and equity stratifiers. Section 2 discusses issues related to finding appropriate data sources for inequality monitoring, including the types of data sources, their strengths, limitations and areas for improvement, and the process of data source mapping. In section 3, a number of measures used to calculate health inequality are introduced; the challenges that arise in their application and approaches to overcome these challenges are detailed. The guiding principles to navigate the task of reporting inequality monitoring are discussed in section 4. Finally, section 5 provides an example of health inequality monitoring in the Philippines, demonstrating how the concepts in sections 1–4 can be applied in the context of low- and middle-income countries.

One important feature throughout this handbook is the use of real examples from low- and middle-income country settings to explain and apply the main concepts. The examples primarily come from the field of reproductive, maternal and child health, because comparable data from low- and middle-income countries are readily available for inequality monitoring on this topic; however, the techniques and methods iii described can be applied to any health topic in any country or at any administrative level. Unless otherwise indicated, the data for the examples contained in this handbook are published in the Global Health Observatory Health Equity Monitor.

Readers of this handbook will encounter informative features throughout the text. This supplementary material appears alongside explanations of theoretical concepts to familiarize the reader with its application and relevance within low- and middle income countries.

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