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Promoting Health Equity

Involving the poor to improve services

Finding innovative approaches to reach the most vulnerable populations are often very difficult for health policymakers around the world. For a variety of reasons, those who often need health services most the poor use them the least. The result: The poor have worse health outcomes than those who are better off. Futures Group asks the poor how to make the system work better for them. We listen, gather feedback on roadblocks, analyze different approaches, and provide new solutions on how to reach these critically important populations. Our EQUITY framework is the repository for this information. With that tool, we are able to accurately quantify the areas of inequities in healthcare access and health status. We uncover the barriers to service and integrate equity goals into policies, plans, and strategies. We work with national leaders to target resources and initiatives that best serve the poor and we encourage public-private partnerships to achieve health equity goals.

Program Areas
population and family planning sexual and reproductive health maternal and child health hiv and aids infectious diseases gender poverty and equity

futures group offerings:

 At every stage in the policy process,

Futures Group ensures that the perspectives of the poor and civil society are represented, from health program planning, to oversight, and monitoring committees.

Technical Services
policy and advocacy research and strategic information  health markets and private sector engagement modeling and economic analysis health systems strengthening strategic consulting program management

W  e analyze inequities in health status, disease burden, and access and use of health services, by looking at socioeconomic status, gender, age, and at-risk populations, among other factors. B  y working on the ground and talking with members of low-income communities and community leaders, we identify barriers to equitable access to service. W  e then introduce these equity goals and approaches at the national level so that these needs are met across a countrys health services, family planning programs, AIDS services, and mother and child health services.

W  e value the input from the poor and help them get involved in community watchdog groups, civil society organizations, and other oversight activities. W  e design, test, and scale up pro-poor financing mechanisms, such as social health insurance, conditional cash transfers, and vouchers schemes. We design and implement innovative, affordable, and scalable public-private partnership service delivery models to ensure sustainable access to quality sevices among the poor

Futures Group One Thomas Circle, NW Suite 200 Washington, DC 20005 U.S.A. tel 202.775.9680 fax 202.775.9694

Record of Results:
Integrated equity policies and methods in programs for family planning and reproductive health across the globe. For example: Uttarakhand, Indias Health and Population Policy, 2010; Kenyas National Reproductive Health Strategy 2009-2015; and Jordans Reproductive Health Action Plan 2008-2012. Helped tie in family planning into development plans in several countries, including Mali and Tanzanias Poverty Reduction Strategy Papers; Rwandas Vision 2020; and Perus Social Insurance Scheme.

Futures Group Europe, Ltd. 2nd Floor Turnberry House 100 Bunhill Row London, EC1Y 8ND U.K. tel +44(0) 20 7250 0556 fax +44(0) 20 7336 8742 Futures Group India, Pvt., Ltd. DLF Building No. 10-B, 5th Floor DLF Cyber City, Phase-II Gurgaon - 122002 (Haryana) India tel 91.124.4702000 fax 91.124.4702042

Approach in Action: India

The ability to pay can be a huge deterrent for people seeking care. For people living below the poverty line in selected areas of states in India Uttar Pradesh, Uttarakhand, and Jharkhand Futures Group started voucher programs to expand access to family planning and reproductive health services. This program, called Sambhav, and funded by USAIDs Innovations in Family Planning Services Technical Assistance Project, produced encouraging results. As Futures Group and our partners monitored the voucher program and analyzed the results, we found out what stopped some community members from seeing a health profession. Building on the existing system and working closely with the government and private sector, we helped establish an affordable pricing system. In the meantime, the vouchers allowed patients to receive antenatal care, postnatal care, family planning, and neo-natal care for free. The results: the delivery of 12,500 babies in private health facilities; 44,000 antenatal care visits; 10,300 postnatal care visits; and 9,500 vouchers for a range of family planning methods. Uttar Pradesh has expanded the voucher system from 368 urban slums in one city to 1,562 slums in five cities: Kanpur, Agra, Varanasi, Allahabad, and Lucknow. A number of factors contributed to the success of the program, allowing us to fulfill the goals of promoting greater equity in a key health service. Futures Groups relied on evidence to design the program, and we incorporated suggestions from the poor. We used existing systems, which encourages sustainability and ownership, and we ensured sustainable financing working with both governments and the private sector. And we developed multiple communication strategies to promote demand for the product.

Photo Credit: World Bank

Our voucher program opened up the health care system to so many people who simply couldnt afford it. It provided excellent private sector services at deep discount rates, expanded services cost-effectively in light of the under-staffing at government facilities, and allowed poor clients to get services they otherwise would not have received. Suneeta Sharma Director Futures Group India

The EQUITY Framework for Health

In response, the USAID | Health Policy Initiative, Task Order 1, designed the EQUITY Framework for Health to provide stakeholders with practical guidance on how to ensure that the voices of the poor are actively engaged in policymaking and that pro-poor strategies are incorporated throughout the policy-to-action process. In this framework, equity is both the goalsomething to strive forand a way of working that involves the poor and integrates equity concerns and approaches.

Giving birth, avoiding debt

For many poor families, an occasion of great joy the birth of a child becomes a financial stranglehold later in their lives. In 2005, in the city of Agra, Abha, 25, delivered her first child in a private hospital by Cesarean section. But for Abha and her husband, a day laborer, the hospital bill soon overshadowed their wonderful moment. The cost was 20,000 rupees, or nearly US$400, and for the next several years they struggled to pay it off. A few years later, Abha became pregnant again. This time, a voucher system set up by Futures Group enabled her to deliver her second child, also by Cesarean, for no cost. For the family, the aftermath from the first two births couldnt have been more starkly different. They were not burdened by new crippling debt after the second birth, and that made a world of difference to them and their new family.

Futures Group, the global health consulting firm, helps to protect and promote peoples well-being around the world. For 40 years, Futures Group has created lasting solutions to some of the most pressing public health challenges facing nations. For more information, please visit,, and