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A massive new dataset to help promote health equity and financial protection in health

Adam Wagstaff's picture

Today we’re (re)launching HEFPI—aka the Health Equity and Financial Protection Indicators database. HEFPI sheds light on two major concerns in global health: a concern that the poor do not get left behind in the rush to achieve global health goals; and a concern that health services should be affordable. Neither concern featured in the MDGs; both feature prominently in the SDGs.

The HEFPI database draws on data from over 1,600 household surveys, including the Demographic and Health Survey and the Multiple Indicator Cluster Survey. Most of the 1,600 surveys have been re-analyzed in-house to ensure comparability across surveys and years, since published indicators from different surveys often use different definitions. We have settled on a definition based on recommendations in the relevant literature, and have used that across all surveys and time periods. As a result, the numbers in HEFPI are often different from (and more comparable than) numbers published elsewhere.

The database is, in effect, the fourth in a series. The first was in 2000. That database focused entirely on MDG-era health service and health outcome data—so no financial protection data. It covered just 42 countries, each with one year’s worth of data. The second (in 2007) and third (in 2012) gradually expanded the scope, with the 2012 dataset covering both financial protection and health equity, and getting up to 109 countries, including some high-income countries.

The database launched today still includes data—for the population as a whole, as well as for different ‘wealth’ quintiles’—the ubiquitous MDG-era indicators, such as antenatal care, skilled deliveries, immunization, childhood stunting, and infant mortality, are all still in the database. But the 2018 database also includes several SDG-era indicators, including cervical cancer screening, hypertension treatment, inpatient admissions and obesity (see chart below). On the financial protection side, the 2018 database includes the fraction of the population spending more than 10% of their budget on out-of-pocket medical expenses (SDG indicator 3.8.2), as well as the incidence of impoverishing out-of-pocket expenses at the $1.90-a-day and $3.20-a-day poverty lines.

The HEFPI database can be downloaded in its entirety here. A data portal where you can produce customized data visualizations is available here. Details of the database are available in a working paper. And a quick overview of the database is in this Lancet Global Health commentary.

Inpatient admissions are higher in high-income countries than low-income countries; cervical cancer screening is much higher. In low- and high-income countries, rates of cervical cancer screening are higher among the better off; hospitalization rates are higher among the less well off in high-income countries but higher among the better off in low-income countries.

Source: Health Equity and Financial Protection Indicators (HEFPI) database, World Bank

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