Contribution to MMI Annual Report 2013
The health of the most poor and marginalised communities around the world will not be improved without better data collection practices. The Millennium Development Goals (MDGs), which run until next year, and the data collection practices behind them hide the truth about the health of ethnic minorities and hinder global development.
We know that across the world, ethnic and cultural minorities are marginalised. They experience more poverty and worse health outcomes than the rest of the population. However, there is a lack of statistical information to show this. The MDGs measure national averages, and do not disaggregate the data into sub-national groups. Improvements for one section of a country’s health can hide a lack of progress for those communities more marginalised and more difficult to help (perhaps due to remoteness, language or cultural barriers).
Better information on health and poverty will improve understanding of how to address the health inequalities faced by marginalised people. Reliable and disaggregated data can ensure that no section of society is overlooked in the efforts to achieve the MDGs and whatever goals are set in the new development framework beyond 2015.
Health Poverty Action works with some of the poorest and most marginalised communities around the world. Our experience in countries across Asia, Africa and Latin America shows that ethnic minorities are being left behind. Ethiopia is one of the countries in which this is happening.
Ethiopia: Semi-mobile pastoralists left behind
Health Poverty Action prioritises those missed out by others and we are working in Ethiopia to improve the health of pastoralists, with a particular focus on women and children.
Ethiopia has one of the world’s highest maternal mortality rates, alongside one of the world’s lowest rates of health spending per person. Across the country as a whole, 350 mothers die for every 100,000 live births and about nine in 10 births are not attended by a skilled health worker. Whilst these statistics are stark, at Health Poverty Action we know that the figures for pastoralist groups are actually much worse. There is some data to back this up, using the proxy of geographic regions with a concentration of pastoralist populations. For example, the use of family planning methods helps to avoid mother and child deaths by preventing unwanted pregnancies and the occurrence of illegal abortions that often have complications that prove fatal; despite their importance, only 9.5% and 5% of women use contraception in the Afar and Somali regions respectively, compared to a national average of 29%. These regions traditionally have a high concentration of pastoralists, giving an idea of the huge disparities amongst different groups. But for a comprehensive picture on which to base targeted and effective development policy, there needs to be much more information on the specific health situation faced by pastoralists.
There are approximately 12-15 million people belonging to 29 different ethnic groups in the pastoral regions of Ethiopia. They are dependent on nomadic livestock production and are often isolated from the already poorly equipped health services. In the Hamer and Dassenach Districts of South Omo, a midwife working with Health Poverty Action speaks of the challenges facing health workers working in poor conditions: there is no electricity in the delivery room, “so when a mother gives birth at night we only use torches.”
As well as poor equipment, there are not enough health workers in these regions of Ethiopia. The Government of Ethiopia has deployed a huge number of Health Extension Workers (HEWs) in the last few years in order to increase access to and coverage of health services. But coverage remains low and turnover high in the remote regions where pastoralists live. Health Poverty Action is supporting these workers to improve the quality of these health services through on-the-job training.
Beyond the general problems of poor equipment and staffing, there are specific interventions that can be used to adapt health services for nomadic communities, such as mobile/outreach clinics and community-constructed birthing huts/maternity waiting homes. Non-Governmental Organisations like Health Poverty Action can implement these culturally appropriate measures with small numbers of communities, but to get these rolled out to all pastoralist communities, the state authorities need to be persuaded of the scale of the problem and the need for intervention. If health data were broken down, the problems faced by pastoralists could be more widely understood and highlighted, and the impact of any culturally sensitive measures could be tracked.
At Health Poverty Action we believe that everybody has an equal right to the best chance at good health. Whilst there are some huge gains being made towards this goal it cannot be realised until the truth about the inequities in health and well-being is exposed via the use of disaggregated data. Health Poverty Action is urging the UK government to champion the disaggregation of data by ethnicity, including advocating for the indicators set to measure progress in the post-2015 framework to be broken down by ethnic and cultural group, and substantial investment to be made in national level statistical capacity building.
It is only when the truth about the inequities faced by millions of the poorest and most marginalised people is exposed, that millions of people will stop being denied their right to health.
Contribution to the Annual Report 2013 of the MMI Network
More information: www.healthpovertyaction.org