Equity considerations in the pre-implementation phase and needs assessment process
L Dancero, H Križan, CD De Ambroggi, M Garcia-SierraAbstract
Issue/problem
The Community Action for Health methodology incorporates a strong equity perspective, ensuring actions to reduce health inequities across contexts. Pilots are empowered to think of equity not only as an outcome but also as a guiding lens when designing actions and as an ongoing, locally tailored process that can outlast the action itself. The guiding principles for ensuring an equity lens during implementation include: embedding a Health in All Policies approach, diversity and inclusivity in group composition beyond numerical representation to address power dynamics, awareness of social and commercial determinants of health and management of conflicts of interest, and including equity as a quality criterion in policies and actions.
Description of the problem
Specific guidance on equity issues related to the setting selection, core group and health network formation, and participatory needs assessment was provided to all 48 pilots. Their implementation was monitored through 3 structured templates over the first 2 years of the project (2024-2025).
Results
Most pilots (38) integrated equity principles into their planning process and expressed willingness to refine the pilot’s objectives accordingly. However, 22 have not yet reviewed the core group composition to identify missing community perspectives, while 33 identified population groups that are more marginalised or vulnerable in relation to the health issue addressed.
Lessons learned
A key lesson is the need for a shared, practical understanding of equity. Many pilots still equate it with inclusion or universal access, without considering how inequalities persist within seemingly homogeneous groups or how participation is structured and which structural barriers shape health outcomes. The main challenge is moving from acknowledging equity to operationalising it; yet the progression observed across steps shows a gradual improvement, suggesting the methodology is gaining atraction