Country classification by income has traditionally guided international decision-making, but there is an increasing concern that policies based on income overlook important dimensions of development, such as poverty, inequality and health need. This is coupled with the reality that the number of countries in the low-income category has progressively declined as they move into the middle-income category, which is currently the largest grouping of countries. The Equitable Access Initiative set out to develop a health framework based on a broader set of economic and health indicators to better inform decision-making on health and development.
The initiative developed a new policy framework to better understand and categorize countries based on their health needs and capacities as they move along the development continuum.
The initiative recommended that policymaking should not rely solely on a single variable to inform complex health financing decisions, and suggested considering health need relative to income levels, as well as domestic capacity and policies. The supporting analysis found that GNI per capita is an imperfect proxy for understanding health need or a government’s capacity to invest in health. The metric is, however, a reliable starting point for assessing the average level of wealth or general economic capacity in a context.
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The convening partners of the Equitable Access Initiative include the World Health Organization; the World Bank; Gavi, The Vaccine Alliance; UNAIDS; UNICEF; UNDP; UNFPA; Unitad; and the Global Fund, with support from the Bill & Melinda Gates Foundation and the Wellcome Trust.
In February 2015, 100 delegates from the global health community, development banks, governments and civil society attended the initial meeting on the Equitable Access Initiative held in Geneva, hosted by the WHO and co-chaired by Pascal Lamy, former Director-General of the World Trade Organization, and Donald Kaberuka, former President of the African Development Bank Group.
Subsequently, four analytical groups were commissioned to develop potential frameworks for consideration by the Equitable Access Initiative stakeholders. Throughout the initiative, an extensive consultation process engaged government representatives, technical partners, civil society, the private sector, academic institutions and think tanks, gathering constructive feedback on the analytical work.
A high-level meeting in February 2016 reconvened members of the Equitable Access Initiative in Geneva to discuss the findings and recommendations of the analytical groups. The four leading academic groups are the University of Oxford, the Norwegian Institute of Public Health, the University of Sheffield-Imperial College and the Institute of Health Metrics. Each of their reports is available for download below.
The Equitable Access Initiative published its report in December 2016.