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METHODOLOGY
Open Access

Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries

Nirali M Chakraborty, Kenzo Fry, Rasika Behl and Kim Longfield
Global Health: Science and Practice March 2016, 4(1):141-154; https://doi.org/10.9745/GHSP-D-15-00384
Nirali M Chakraborty
aPopulation Services International, Washington, DC, USA
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Kenzo Fry
bIndependent consultant, London, UK
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Rasika Behl
cUniversity of California, Global Health Group, San Francisco, CA, USA
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Kim Longfield
aPopulation Services International, Washington, DC, USA
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Many program implementers have difficulty collecting and analyzing data on program beneficiaries’ wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.

ABSTRACT

Background: Social franchising programs in low- and middle-income countries have tried using the standard wealth index, based on the Demographic and Health Survey (DHS) questionnaire, in client exit interviews to assess clients’ relative wealth compared with the national wealth distribution to ensure equity in service delivery. The large number of survey questions required to capture the wealth index variables have proved cumbersome for programs.

Methods: Using an adaptation of the Delphi method, we developed shortened wealth indices and in February 2015 consulted 15 stakeholders in equity measurement. Together, we selected the best of 5 alternative indices, accompanied by 2 measures of agreement (percent agreement and Cohen’s kappa statistic) comparing wealth quintile assignment in the new indices to the full DHS index. The panel agreed that reducing the number of assets was more important than standardization across countries because a short index would provide strong indication of client wealth and be easier to collect and use in the field. Additionally, the panel agreed that the simplified index should be highly correlated with the DHS for each country (kappa ≥ 0.75) for both national and urban-specific samples. We then revised indices for 16 countries and selected the minimum number of questions and question options required to achieve a kappa statistic ≥ 0.75 for both national and urban populations.

Findings: After combining the 5 wealth quintiles into 3 groups, which the expert panel deemed more programmatically meaningful, reliability between the standard DHS wealth index and each of 3 simplified indices was high (median kappa = 0.81, 086, and 0.77, respectively, for index B that included only the common questions from the DHS VI questionnaire, index D that included the common questions plus country-specific questions, and index E that found the shortest list of common and country-specific questions that met the minimum reliability criteria of kappa ≥ 0.75). Index E was the simplified index of choice because it was reliable in national and urban contexts while requiring the fewest number of survey questions—6 to 18 per country compared with 25 to 47 in the original DHS wealth index (a 66% average reduction).

Conclusion: Social franchise clinics and other types of service delivery programs that want to assess client wealth in relation to a national or urban population can do so with high reliability using a short questionnaire. Future uses of the simplified asset questionnaire include a mobile application for rapid data collection and analysis.

  • Received: 2015 Dec 4.
  • Accepted: 2016 Feb 15.
  • Published: 2016 Mar 21.
  • © Chakraborty et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-15-00384.

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Global Health: Science and Practice: 4 (1)
Global Health: Science and Practice
Vol. 4, No. 1
March 21, 2016
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Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield
Global Health: Science and Practice Mar 2016, 4 (1) 141-154; DOI: 10.9745/GHSP-D-15-00384

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Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield
Global Health: Science and Practice Mar 2016, 4 (1) 141-154; DOI: 10.9745/GHSP-D-15-00384
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    • ABSTRACT
    • INTRODUCTION
    • APPROACHES TO MEASURING WEALTH
    • CONVENTIONAL WAYS OF MEASURING EQUITY IN SOCIAL FRANCHISING
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