I probably grew up with the word “health” crossing my ears almost every day. It is one word that became too common to bother checking my dictionary for the meaning. Being a person from a non-medical professional background, I understood health provision services to be the responsibility of medical professionals. As such, I felt so isolated from the health field and never realized that health is a diverse field in which every person has a role to play. Thanks to Global Health Corp (GHC), I finally took a moment to consult my dictionary for the definition of health.
When I read the GHC ad in one of our local newspapers for the first time, something was unique to me. I realized throughout their text, the word “equity” came after “health.” I paused for a moment and I asked myself whether the word health has been changed to health equity or maybe at this point I needed to check my dictionary for the definitions of “health,” “equity,” and “health equity.”
As I now get to work in health, I realize people working this field need to be impact driven much more than people working in other fields because in health, we want to save human lives. And since we want to save a life, our impact would never be defined beyond magnitudes of lives saved. At this point, as an advocate in health, I have made sense of why the word health should be accompanied by “global” and “equity.”
Now as a GHC Fellow working on National Cervical Cancer Prevention Programme in a low resource country where the demand for the “Screen and Treat” services are too huge to define eligibility, coupled with high HIV and AIDS levels across age groups, I never forget in my everyday work the mantra that “Health is a human right.” Our “Screen and Treat” approach provides equal access to screening services to all women regardless of their social or economic status. Now this is “health equity” and “health as a human right” at play. However, considering the high demand for the service, it drives me to rethink the health equity concept and link it to achieving maximum impact.
Impact in our case is reduced mortality by cervical cancer, which drives my passion for identifying who in our target group is at high risk of contracting cervical cancer. It is well known that HIV and AIDS infected women are at high risk while their utilization of the screening services has significantly decreased from programme inception. HIV positive women prioritize ART services, which makes them visit health centers regularly. Accessing a cervical cancer screening requires making an appointment at the health center, which is not feasible for HIV positive women. Thus, the majority would prefer to access a screening service on the same day they came for ART service.
As much as we are able to screen large numbers of women on a daily basis, the percentage of HIV positive clients is decreasing, resulting in a reduced number of clients who test VIA positive. This calls for the need to develop an internal strategic system that prioritizes coverage of this subgroup without inducing stigma. That way, we will have increased coverage of the most vulnerable groups, and therefore increase VIA positive tests and treatment, reduce long-term mortality, and increase our impact. And now contextualizing my belief that health is a human right to my current job, humans with high risk of contracting the disease deserve priority of access to screening and treatment services. If we increased access of the service to the most vulnerable target populations, would that mean equity? I have no greater motivation during my fellowship than my passion for promoting equity of access to screening services for vulnerable groups, maximizing our impact. As one of many activities during my yearlong fellowship, I have given my particular attention to sites doing well in this area. I document their practice, make necessary modifications, pilot a standardized practice, and, if it succeeds, introduce and reinforce it at all sites.
Women queuing for screening services at Adult Infectious Disease Center, University Teaching Hospital.