How do high-level African directors of policy and planning operationalize health equity? Findings from a regional survey

This study investigates the operationalization of health equity and associated challenges faced by directors of policy and planning and those in related positions in the African Region. The results of this study demonstrate that health equity is generally a priority for policymakers in practice and is operationalized in four ways: (i) targeting priority groups, (ii) focusing on the entire population; (iii) through procedural justice; and (iv) operationalizing population health data. The targeted approach, which predominated, tended to focus on individuals with lower socioeconomic status, maternal and child health services, and select infectious diseases (e.g., HIV/AIDS). The population-wide approach entailed the inclusion of health equity in institutional laws, constitutions, and national policies with efforts to ensure access to health services for all. Procedural justice largely focused on the inclusion of stakeholders in decision-making processes. Lastly, operationalizing population health data was noted to guide policy and planning to address health inequities, often through aiding in the selection of priority groups or areas for intervention and monitoring and evaluation actions focused on improving health equity. Four main domains of challenges for incorporating health equity emerged relating to: (i) understanding health equity, (ii) governance, (iii) resources, and (iv) lack of data. Our recommendations are two-fold: (i) we recommend that researchers focus on improving understandings of health equity among policymakers through knowledge translation and exchange, and (ii) we recommend that policymakers and those working within donor organizations focus on reforming any top-down processes through which priorities are set and decisions are made.Author summary: Health equity remains a key goal for policymakers globally. Our study explores how health equity is understood and put into practice by directors of policy and planning and those in related positions in the African Region. After distributing a survey, we found that health equity is prioritized in four ways: (i) by targeting specific groups, (ii) by focusing on the entire population, (iii) through direct inclusion of the population in decision-making processes, and (iv) by using health data for policy and planning decisions. Notably, the most common approach focused on targeted policies and interventions for individuals with lower socioeconomic status, maternal and child health services, and select infectious diseases. Despite these actions on health equity, policymakers shared that challenges remain relating to: (i) understanding health equity, (ii) governance, (iii) resource constraints, and (iv) lack of data. We recommend that: (i) researchers focus on improving understandings of health equity among policymakers through sharing knowledge, and (ii) policymakers and those working within donor organizations focus on reforming any processes where decisions and priorities are imposed, non-participatory, or not inclusive (i.e., top-down processes).