Poverty and Equity

Theresa Finn, MEASURE Evaluation

Pro-poor programs need quantitative measures to plan activities and monitor progress. MEASURE Evaluation has developed low-cost, reliable procedures to measure health inequalities.

The poor often have greater health needs. Programs must address factors that influence service use. What is the best way to measure poverty – the best data to collect, the best ways to collect and analyze them? Are different measures needed for urban and rural areas?

Many studies have found that wealth indexes based on household ownership of consumer durables and dwelling characteristics perform quite well to analyze relationships between socioeconomic status (SES) and health service use and outcomes. The data are easily included in household surveys and the summary measures relatively simple to calculate.

MEASURE Evaluation research suggests ways to improve on the current methods used to impute SES from household survey data. For example, polychoric Principal Components Analysis (PCA), which is designed for categorical data, is more appropriate for most household survey data than the versions of PCA currently used. Furthermore, common practice is to calculate a single SES index for the entire country. MEASURE Evaluation analyzed DHS data from several countries to determine how best to separate SES by place of residence. Findings suggest that, at the macro level, re-ranking the national SES index into separate urban/rural quintiles may be sufficient for tracking health inequalities in urban and rural areas.