Modelling¹ to determine the cost-effectiveness of an equity-focused approach to child survival, health and nutrition was carried out by UNICEF by combining Marginal Budgeting for Bottlenecks Toolkit (MBB) and the Lives Saved Tool in 2012 and the analysis published in the Lancet in September 2012 showed that disproportionately higher effects are possible by prioritizing the poorest and most marginalised populations for averting both child mortality and stunting.

This initial analysis helped develop a framework 'Equitable Impact Sensitive Tool' and a study was undertaken by populating the tool with necessary data and conduct the first implementation of EQUIST in studying the cost-effectiveness of community case management of childhood pneumonia in 5 low - and middle-income countries with relation to equity impact. The study² was published by the Centre for Population Health Sciences and Global Health Academy, The University of Ediburgh Medical School in the Journal of Global Health in December 2012.

UNICEF has further developed the EQUIST as a powerful web-based free-access, analytical platform designed to help decision-makers develop equitable strategies to improve health and nutrition for the most vulnerable children and women. It incorporates the functionality of Lives Saved Tool (LiST)³ in its back-end to model lives saved and uses data and principles from the Marginal Budgeting for Bottlenecks (MBB) tool for its costing component. EQUIST identifies cost-effective interventions, prioritizes key bottlenecks that constrain their coverage and targets the most effective and equity-focused strategies that can address these bottlenecks to increase MNCH intervention coverage and fast track the reduction of maternal and child mortality, especially among deprived populations.ulation Health Sciences and Global Health Academy, The University of Ediburgh Medical School in the Journal of Global Health in December 2012.

EQUIST helps UNICEF and its partners to work with national partners to adapt and apply EQUIST as an evidence-based and equity-focused planning tool to prioritize country strategies and health strategy plans as well as develop prioritised investment cases in order to improve strengthen health system components and raise the coverage of high impact reproductive, maternal, newborn and child and adolescent health and nutrition (RMNCAH&N) interventions. EQUIST will help countries focus on Primary Health Care programmes that will help achieve countries achieve Universal Health Coverage in their pursuit to achieving health and nutrition related Sustainable Development Goals.

The application of EQUIST involves:

• Building Capacity: developing the capacity of technical and managerial personnel within Ministry of Public Health, UNICEF, WHO and other UN agency staff, academic and research staff, government officials and key national partners;
• Conducting Scenario Analyses: supporting stakeholders in identifying priority populations, interventions, bottlenecks and operational strategies, and estimating the required additional resources for strengthening various elements of health system;
• Facilitating Dialogue: facilitating policy dialogue among key decision makers, to support key decisions on priority interventions and strategies; and
• Documenting Lessons Learned: capitalizing on the lessons learned in the process through: 1) systematic documentation; and 2) peer-to-peer experience sharing (e.g. community of practice, learning tours, coaching and mentorship). As a result of these activities, countries have the opportunity to:
  • Develop evidence-based, equity-focused strategies and enhanced plans for MNCH and nutrition;
  • Mobilize and re-allocate resources to address remaining gaps in strategic plans; and
  • Institutionalize an equity-based approach to planning and health systems strengthening (HSS).

 

1. "The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: a modelling approach" Lancet 2012: 380: 1341-51 (http://dx.doi.org/10.1016/S0140-6736(12)61378-6).

2. "Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality: An application of Equitable Impact Sensitive Tool (EQUIST) in five low- and middle-income countries" Journal of Global Health December 2012 Vol. 2 No. 2 (http://dx.doi.org/10.7189/jogh.02.020402).

3. The Lives Saved Tool (LiST), developed by the Institute for International Programs (IIP) at Johns Hopkins Bloomberg School of Public Health and funded by the Bill & Melinda Gates Foundation, is a model that estimates the impact of scaling up health and nutrition interventions on newborn, child, and maternal health.