Female student taking the COVID vaccine in the clinic by a nurse

Equity and Social Determinants of Health in Health Information Systems

This initiative is carried out by the Social Research Center of The American University in Cairo (SRC-AUC), in collaboration with the faculty of Health Sciences in The American University of Beirut (FHS-AUB) and with support from the International Development Research Center (IDRC) of Canada.

About

The project moves the current narrow framing of Health Information System (HIS) into a broader framing that captures the Social Determinants of Health (SDH) as the root cause of inequity in health status. The project is divided into three phases.

  • The first phase covers a conceptualization and development of indicators 
  • The second phase is the engagement of pertinent stakeholders in Morocco, Jordan, and relevant applications
  • The third phase covers wider regional dissemination and outreach, as well as documentation efforts

The second and third phases will be implemented in parallel, with more emphasis on implementation in the second phase and on regional dissemination in the third phase.

The Health Information System (HIS), when adequately conceptualized and developed, can support both policy and program level changes. This is carried out through the development of two packages of indicators one for policy level and the other for program level.

At the policy level, the proposed package of indicators aims to support the building of the whole government’s commitment and wider participation of key stakeholders in addressing the inequitable distribution of health. The proposed package of indicators will guide the movement from a health care preventive modeled by the health sector to a health equity promotion model led jointly by social and health sectors.

At the program level, the proposed package aims to ensure that program planning and implementation are recognizing the root causes of the disadvantage in the targeted groups and are adopting a participatory multisectoral collaborative model. With an application on a specific reproductive health program, the proposed package of indicators supports the incorporation of the missing social dimensions of health and very much needed structural determinants of gender equity in the planning and implementation of interventions.

Objectives 

The research project seeks to strengthen the role of HIS in guiding policy change and improving the effectiveness of health programs for the purpose of achieving health equity. The project supports policy-level changes, as well as guides program implementation.

The main objective is to adopt a social framing and a set of indicators in HIS, and to support relevant stakeholders to utilize them towards advocating for health equity and implementing the social determinants of health (SDH) approach in policies and programs. The project also demonstrates the potential of the proposed HIS to inform implementation by engaging with programs addressing a specific sexual and reproductive health (SRH) challenge.

More specifically, the project aims to:

  1. Guide policies through:

    1. Proposing an information system for health that allow measuring, tracking and summarizing health inequalities across relevant dimensions of social groupings

    2. Expanding the coverage of the information system to capture structural determinants and actions on the distribution of these determinants

    3. Developing capacities to manage and utilize HIS to inform policies and guide actions

    4. Giving visibility to social inequalities in health and supporting informed public demand for just alternatives, monitoring and accountability

  2.  Support program implementation with an equity lens through:

    1. Promoting the application of the developed HIS on a specific SRH program in two countries of the region through

    2. Ensuring adoption of gender and rights approaches and clear consideration of equity dimensions in each implemented program

Project Team

Principal Investigators

Jocelyn DeJong 
Professor and Associate Dean
Faculty of Health Sciences, American University of Beirut, Lebanon

Hoda Rashad 
Research Professor and Director
Social Research Center, The American University in Cairo, Egypt

Co-Principal Investigators

Sherine Shawky
Senior Research Scientist
Social Research Center, The American University in Cairo, Egypt

Zeinab Khadr
Senior Research Scientist
Social Research Center, The American University in Cairo, Egypt

Country Coordinators

Kareman Alzein
Community Medicine specialist, Jordan

National Researchers

Ahmad H. Al-Nawafleh
Associate Professor, University of Mutah, Jordan

Abdel Salam Boutayeb
Professor, Département de Mathematiques Faculté des Sciences Oujda, Morocco

Advisory Board

Maha Eladawy
Director, Healthier Populations Department (HPD)
World Health Organization Regional Office for the Eastern Mediterranean

Rajae Elaouda
Clinical Biologist ​-​Director LABELAOUAD
Resident Member 
Hassan II Academy of Science and Technology, Morocco

Arash Rashidian
Director of Science, Information and Dissemination
World Health Organization Regional Office for the Eastern Mediterranean

 

Project Activities and Expected Outputs

Project Activities

Our project approach is anchored on the SDH framework. It will bring together and make use of the different international contributions that attempted to monitor inequalities, conceptualize and measure upstream structural drivers, as well as to integrate an equity/SDH lens in health systems.

The countries chosen for implementations are Morocco and Jordan. These countries are committed to equity and appreciative of the role of social drivers. They exhibit two important features: successful previous collaborative efforts between the implementers of the project and relevant bodies and stakeholders in Jordan and Morocco, a reasonable information base that is expected to allow successful measurement of the proposed indicators.

The programmatic focus is a reproductive health program in each of these countries. Such a focus is explained by the fact that this dimension of health is receiving increased attention within the health sector programs and that data on reproductive health challenges and their social distribution are reasonably available (particularly in Demographic and Health Surveys).

Furthermore, the focus on the reproductive health program in different countries provides an appropriate platform to demonstrate the ill-health impact of gender norms and biases and allows the recommendations of needed evidence-based reorientation of policies and programs to address these biases.

The contributions of the proposed activity, in relation to gender, aims to:

  • Construct a proxy measure of gender norms based on the few pieces of information currently available in surveys
  • Carry out an analytical and methodological effort to place gender norms as a social category, clarifying its pathways of influence on health and its structural determinants that lend themselves to actions. Such an effort will be based on the assessment of gender norms across a continuum from the most to the least restrictive (equitable) with regard to gender and a decomposition analysis demonstrating the contribution of inequality in gender norms in producing inequality in reproductive health
  • Identify the knowledge gaps that allow more sensitive measures of gender norms and power relations, as well as of social and mental health

Project Outputs

  • Background papers on the HIS
    • Background paper: Setting the Stage for an Information System for Health. Read More
    • A Review Paper on HIS in Morocco. Read More
    • A Review of Social Determinants of Health Inclusion in Health  Information System in Jordan(Paper submitted for publishing to be share once accepted by the journal)
  • A core general package for the HIS
  • A specific package for sexual and reproductive health (SRH)
  • A report on gender norms as a social stratified
  • A meeting with experts and stakeholders from Jordan and Morocco to discuss and approve the two packages, as well as identify an SRH program to participate in years 2, and 3 of activities.
  • Collaborating with an SRH program implemented in Jordan and Morocco. The objective is to support integrating an equity and SDH lens in program implementation and evaluation.