Improvement studies for equitable and evidence-based innovation: an overview of the 'IM-SEEN' model.

BACKGROUND: Health inequalities are ubiquitous, and as countries seek to expand service coverage, they are at risk of exacerbating existing inequalities unless they adopt equity-focused approaches to service delivery. MAIN TEXT: Our team has developed an equity-focused continuous improvement model that reconciles prioritisation of disadvantaged groups with the expansion of service coverage. Our new approach is based on the foundations of routinely collecting sociodemographic data; identifying left-behind groups; engaging with these service users to elicit barriers and potential solutions; and then rigorously testing these solutions with pragmatic, embedded trials. This paper presents the rationale for the model, a holistic overview of how the different elements fit together, and potential applications. Future work will present findings as the model is operationalised in eye-health programmes in Botswana, India, Kenya, and Nepal. CONCLUSION: There is a real paucity of approaches for operationalising equity. By bringing a series of steps together that force programme managers to focus on groups that are being left behind, we present a model that can be used in any service delivery setting to build equity into routine practice.

Leveraging HIV Programming to Enhance Access to Noncommunicable Disease Care in Southern Botswana.

OBJECTIVE: The objective of this study was to assess whether HIV programming in southern Botswana could be leveraged to provide care for patients with noncommunicable diseases (NCDs). METHODS: A retrospective analysis was performed to determine the spectrum and complexity of NCDs seen by HIV-focused outreach programming delivered between July 2011 and December 2013, to 9 facilities in southern Botswana. The association of HIV status and specific International Classification of Disease codes was examined using bivariate analysis. RESULTS: Outreach HIV physicians recorded 926 outpatient consults involving 835 patients during the studied period. While 25% (n=209) of patients seen were HIV infected, most patients were either HIV negative (49%, n=410) or had an unknown HIV status (26%, n=216). Noncommunicable disease referrals were as common at primary- and district-level facilities (90% [n=459] versus 93% [n=301]; P=.22). CONCLUSION: This study demonstrates how HIV programming in Botswana can be leveraged to improve access to specialist medical services for patients with NCDs.