Improvement studies for equitable and evidence-based innovation: an overview of the ‘IM-SEEN’ model
Luke Allen, Oathokwa Nkomazana, Sailesh Kumar Mishra, Michael Gichangi, David Macleod, Jacqueline Ramke, Nigel M. Bolster, Ana Patrícia Marques, Hilary Rono, Matthew J. Burton, Min Kim, Bakgaki Ratshaa, Sarah Karanja, Ari Ho‐Foster, Andrew Bastawrous
Abstract
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.