Staff at the ICEH were founding members of the Countdown to 2015: Maternal, Newborn and Child Survival initiative, aimed at monitoring population coverage with effective interventions against the main causes of death among women and children in low- and middle-income countries. Countdown to 2015 was a multi-stakeholder initiative aimed at monitoring progress toward the Millennium Development Goals numbers 4 (Child Survival) and 5 (Maternal Health). The ICEH coordinated Countdown to 2015’s Equity Technical Working Group, and produced all disaggregated analyses included in their website and global reports. With the launch of the Sustainable Development Goals in 2015, the Countdown to 2030 initiative was set in motion with similar goals to those of Countdown to 2015. For this new initiative the ICEH is playing a dual role: as the lead institution for the Equity Technical Working Group, and as the Countdown Regional Hub for Latin America and the Caribbean.
In order to disseminate data on inequalities in Reproductive, Maternal, Newborn and Child Health (RMNCH), a partnership was created between the ICEH and WHO in 2010, through which we provide the analyses made available at the Health Equity Monitor and through the Health Equity Assessment Toolkit. Twice every year, the global database is updated as new RMNCH surveys become available.
Core components of the Health Equity Monitor include disaggregated databases of RMNCH, country equity profiles and interactive visuals. Users may create their own animated graphics based on the data analyzed at the ICEH and GHO.
The partnership between the GHO and ICEH also resulted in the production of the HEAT (Health Equity Assessment Toolkit), a software application for use on desktop or laptop computers and mobile devices, developed in order to facilitate the assessment of within-country health inequalities. HEAT is organized around two main components:
The Lives Saved Tool (LiST) is an interactive tool aimed at projecting the impact of increasing intervention coverage on child survival, allowing countries to select which interventions would be most cost-effective in their context. LiST is based at the Institute for International Programs at Johns Hopkins University, and the partnership with ICEH allows selection of the most cost-effective interventions for specific population subgroups, stratified by wealth quintile, mother’s education or urban/rural residence.
In order to help Gavi in its mission to save lives by increasing equitable and sustainable use of vaccines, a partnership was formed between ICEH and Gavi in 2018. Throughout the years, a team from both institutions has worked in multiple analyses trying to identify drivers of vaccination uptake and inequalities in low- and middle-income countries. Using a global health perspective, the team has worked with a wide range of topics – always connected to vaccination – including: religious affiliation, ethnicity, women's empowerment, multiple deprivation, and vaccine cards. Combined, they help to identify determinants that can be used to target unvaccinated children and tailor interventions to the characteristics of these children, their families and their communities. This partnership has already resulted in 5 published papers (with many others in the works), and countless internal reports and presentations.
One of the main activities of the Center for Equity is the analysis of the National Demographic and Health Surveys. These surveys are conducted periodically and follow the U.S. Demographic and Health Surveys methodologies. The analysis of standardized indicators at different time points provides an overview of the trends of these indicators over time and allows the monitoring of socioeconomic and demographic inequalities. The PNDS collected data among women of childbearing age and children under five in the five macro-regions of Brazil. More methodological details can be found in the final report of each survey available on the PNDS web site.
To date, an interim report of the analyses was submitted to the Brazilian Ministry of Health including the following indicators: modern contraceptive use and delivery in birth centers (1986, 1996, and 2006) and utilization of improved health care facilities (1996 and 2006). These analyses were performed using Stata version 12.0, taking into account the design effect. Estimates were obtained for nationwide coverage, with 95% confidence intervals, stratified by income levels (quintiles), macro-regions (central-west, northeast, north, southeast, south), child’s gender (male or female), mother’s education (none, elementary, middle and high school, and college) and area of residence (urban or rural).
Regarding the indicators assessed, the prevalence of delivery in birth centers was high in 1986 (80.5%), and then rose to 97.6% in 2006. Modern contraceptive use increased sharply from 1986 to 1996, reaching 77.1% in 2006. And utilization of improved health facilities, with data estimates for 1996 and 2006 only, showed a 9% increase during this study period.
In addition to data analysis and production of reports of results on health equity, the UFPel Center for Equity has the goal to keep an updated database of national and international references on health equity. To achieve this goal, the first step was to perform a literature review to identify studies on equity published in Brazil and worldwide to set up a database.
By November 2012, over 1,300 references of scientific articles, book chapters, reports, and other documents available on websites of prominent national and international research institutions were retrieved. Of these, 886 full-text electronic documents were selected to be stored in the Center’s database.
The second step of the database setup will require the identification of the type of documents (conceptual works, reviews, original articles), study population (children, women, schoolchildren), geographic area where the study was conducted (country, state, region), study design (cohort, cross-sectional, case-control), data sources (PNDS/DHS, PNAD, PNSN, Census, POF, among others), type of socioeconomic and demographic stratification (income, education, housing conditions, ethnicity, child gender, among others), outcomes (breastfeeding, low weight, low height-for-age, mortality, among others) and main results report.
Our strategy for effectively handling all documents was to begin with original articles published in journals reporting maternal and child health outcomes in Brazil.