Subnational health management and the advancement of health equity:a case study of Ethiopia

Background:Health equity is a cross-cutting theme in the United Nations 2030 Agenda for Sustainable Development,and a priority in health sector planning in countries including Ethiopia.Subnational health managers in Ethiopia are uniquely positioned to advance health equity,given the coordination,planning,budgetary,and administration tasks that they are assigned.Yet,the nature of efforts to advance health equity by subnational levels of the health sector is poorly understood and rarely researched.This study assesses how subnational health managers in Ethiopia understand health equity issues and their role in promoting health equity and offers insight into how these roles can be harnessed to advance health equity.Methods:A descriptive case study assessed perspectives and experiences of health equity among subnational health managers at regional,zonal,district and Primary Health Care Unit administrative levels.Twelve in-depth interviews were conducted with directors,vice-directors,coordinators and technical experts.Data were analyzed using thematic analysis.Results:Subnational managers perceived geographical factors as a predominant concern in health service delivery inequities,especially when they intersected with poor infrastructure,patriarchal gender norms,unequal support from non-governmental organizations or challenging topography.Participants used ad hoc,context-specific strategies(such as resource-pooling with other sectors or groups and shaming-as-motivation)to improve health service delivery to remote populations and strengthen health system operations.Collaboration with other groups facilitated cost sharing and access to resources;however,the opportunities afforded by these collaborations,were not realized equally in all areas.Subnational health managers’efforts in promoting health equity are affected by inadequate resource availability,which restricts their ability to enact long-term and sustainable solutions.Conclusions:Advancing health equity in Ethiopia requires:extra support to communities in hard-to-reach areas;addressing patriarchal norms;and strategic aligning of the subnational health system with non-health government sectors,community groups,and non-governmental organizations.The findings call attention to the unrealized potential of effectively coordinating governance actors and processes to better align national priorities and resources with subnational governance actions to achieve health equity,and offer potentially useful knowledge for subnational health system administrators working in conditions similar to those in our Ethiopian case study.

The Subnational Penn Effect： Evidence from China

In this paper we estimate relative consumer price levels as of 2008 for 36 major Chinese cities, using an innovative method purposely designed to rectify three main defects of the existing literature, which are （1） the under-representation of marketized services in the sample data, （2） biased consumption weights, and （3） a mismatch between sample classification and consumption weights. Our estimation results show the ＂subnational Penn effect＂ as defined by Tang （2012）, i.e., strong inter-city correlations among population size, the relative price level, per capita nominal and real income, and human capital stock, thereby showing that the theoretical model of inter-city price dispersion proposed by Tang （2012） is applicable in China. Our conclusion, methodology, and estimation results have important implications for various aspects of the Chinese economy including the regional, urban and real-estate economies.

Global spatio-temporally harmonised datasets for producing high-resolution gridded population distribution datasets

Multi-temporal,globally consistent,high-resolution human population datasets provide consistent and comparable population distributions in support of mapping sub-national heterogeneities in health,wealth,and resource access,and monitoring change in these over time.The production of more reliable and spatially detailed population datasets is increasingly necessary due to the importance of improving metrics at sub-national and multitemporal scales.This is in support of measurement and monitoring of UN Sustainable Development Goals and related agendas.In response to these agendas,a method has been developed to assemble and harmonise a unique,open access,archive of geospatial datasets.Datasets are provided as global,annual time series,where pertinent at the timescale of population analyses and where data is available,for use in the construction of population distribution layers.The archive includes sub-national census-based population estimates,matched to a geospatial layer denoting administrative unit boundaries,and a number of co-registered gridded geospatial factors that correlate strongly with population presence and density.Here,we describe these harmonised datasets and their limitations,along with the production workflow.Further,we demonstrate applications of the archive by producing multi-temporal gridded population outputs for Africa and using these to derive health and development metrics.The geospatial archive is available at https://doi.org/10.5258/SOTON/WP00650.