Under the umbrella of the Health Equity 2020 project, conducting the capacity assessment / audit can be two-fold: a) it can enable the interviewer to get an overview of the region / organization / department b) it can motivate stakeholders to co-operate and build partnerships if these have not yet been established or are not strong enough (for example in the form of an RAG).
The person conducting the audit should decide which entry point or capacity domain to start with. Very often the organizational level is chosen as a first stage of analysis because it is the best way to assess existing capacities and anticipated capacity gaps. Moreover it provides an opportunity to address the individual capacities of people working in the current organizational environment as well as the organizational environment later in the course of the interview.
Assuming the organizational level is chosen as a first step, the interviewer should find out how organizational activities are linked to health inequity issues of interest or how it can contribute to a reduction in health inequities. It is important to know whether the reduction of health inequities is an explicit objective of the organization, whether it is on the agenda, whether there is a commitment to address health inequities, whether impacts are “only” a side product of activities or whether there is any awareness at all.
It might be a challenge if an interviewee is not aware of the links or impacts that his/her organization has on a particular inequity issue. For example, a representative of a sector (e.g. education, social services, environment) might perceive health inequities as being addressed by the health sector only. To address this particular barrier it is possible to:
- ask the interviewee to give an overview of the organization and its activities,
- explain the social determinants of health approach to him/her afterwards,
- develop a common understanding about the links between the organization and the issue of interest.
The figure developed by Whitehead / Dahlgren (Figure 27) is very useful as a tool to use during interviews. One can ask the interviewee where they identify links between their organizational activities and health which can be the foundation on which to discuss step-by-step links between school / education, social determinants of health and health inequities. This should be followed by collecting more detailed information of the organizational activities of interest.
When the activities of interest have been specified, it is possible to address the relevant capacities for reducing health inequities. This can be done by showing the interviewee the figure with the key action areas of capacity building (Figure 22) and asking him/her to address the different domains of the respective capacity building framework.
Reflecting on the existing capacities will allow the interviewer to take a step further and ask the interviewee to identify assets and also gaps. Both assets and gaps should become starting points for discussing opportunities and needs for the further development of capacities.
A simple table (Table 6) is helpful to structure the discussion. For each of the domains a couple of topics can be taken into account when collecting information about assets and gaps.
The interviewer can ask the interviewee to assess capacities at other levels as well:
- If the interviewee is a policy maker: the perception of organizational capacities and individual capacities can be reflected upon.
- If the interviewee represents an organization: the perception of enabling environment and individual capacities can be reflected upon.
- If the interviewee is an individual: the perception of organizational and environmental capacities can be reflected upon.
Finally, it is also possible to ask about the interviewee’s impressions of capacities of other stakeholders.
After the interviewer has a list with assets and gaps, their relevance and priorities for the further development of capacities can be discussed. At this stage it is important to address capacities to plan and implement capacity building and development. The following matrix can be used (Table 7) to structure the interview.
|Technical capacities||Engage stake-holders||Assess a situation and create a vision and mandate||Formulate policies and implement||Evaluate|
Essential questions are: to what degree do core issues such as institutional arrangements, leadership, knowledge and accountability allow the development of capacities by engaging relevant stakeholders, assessing a situation and creating a vision and a mandate, formulating policies and strategies, budget management and implementation as well as evaluation? What is supportive, what is a hindrance to the development of capacities to address health inequities in another, better, more effective way? E.g.:
- Are health systems routinely designed and implemented to take the specific needs of vulnerable groups into account?
- What about the capacities to engage cross-sector planning and action within and outside the health system?
- Are there mechanisms formally supporting planning and implementing of cross-sector action in tackling health inequities?