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 of mother and children. The Countdown 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 the Equity Technical Working Group of the Countdown to 2015, 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 launched with similar objectives to those of the Countdown to 2015, and 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, maternal education or urban/rural residence.
One of the main activities of the Center for Equity is the analyses of the National Demographic and Health Surveys. These surveys are conducted periodically following 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 monitoring socioeconomic and demographic inequalities. The PNDS collected data among childbearing age women 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.
An interim report of the analyses was submitted to date 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. There were estimated the nationwide coverage and 95% confidence intervals, stratified by income levels (quintiles), macro-regions (central-west, northeast, north, southeast, south), child gender (male or female), maternal 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 analyses 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 works on equity published in Brazil and worldwide to set up a database.
By November 2012, there were retrieved over 1,300 references of scientific articles, book chapters, reports, and other documents available on websites of prominent national and international research institutions. Of these, 886 full-text electronic documents were selected to be stored in the Center for Equity database.
The second step of the database setup will require to identify the type of documents (conceptual works, reviews, original articles), study population (children, women, schoolchildren), geographic area where a 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 out all documents was to begin with original articles published in journals reporting maternal and child health outcomes in Brazil.