Equity in Service Delivery (10 questions: program self-assessment)

10 questions that ask about equity in service delivery, as a self-assessment tool for organizations providing heath care services.


Demo survey using 5-point scale instead of 10-point scale

This measure is a self-assessment rating tool for organizations providing health care services. It can be used as a worksheet to assess capacity in the 10 equity-oriented strategies defined by EQUIP Health Care (see references).  Organizations review the score for each of ten strategies to identify areas of strength and growth.


Rate your organization, where 0 = “not at all attending to this strategy”, and 10 = “fully attending to this strategy”.

  1. Explicit commitment to equity: Equity is identified as a strategic priority of the organization and leadership is committed to improving equity at all levels of the organization.
  2. Supportive structures, policies, and processes: Structures, policies, and processes related to hiring, performance evaluation, recognition, rewards and compensation, continuing education, and staff meetings all are viewed with respect to equity. For example, staff whose values align with the commitment to equity are recruited, hired and retained. There are also dedicated resources in the budget to support equity work.
  3. Re-envision how time is used: For example, flexibility with scheduling appointments recognizing patients facing structural vulnerabilities may not arrive on time, or keep scheduled appointments, or may only seek emergency care. How well does the practice accommodate patients seeking more time for procedures? How well are the tensions between the need to produce (efficiencies) and the needs of priority patient groups (appropriateness) planned and accounted for?
  4. Attend to power differentials: In your organization, this refers to all staff having some influence on how the organization’s work activities are carried out. During interactions with patients, this means paying attention to how you might be perceived as intimidating to patients, regardless of your intention or actions that are aimed at making patients feel comfortable and welcome.
  5. Tailor care, programs and services to context: Context refers to the broader cultures, structures, political systems, and local communities within a particular place. It is important to know and understand these to effectively tailor services to local contexts. How well has the organization tailored care to uniquely address the known barriers to access care for underserved populations? How distinct is the organization from mainstream practices? For example, how well are financial barriers addressed for people without benefits or with public plans and experiencing poverty?
  6. Actively counter racism and discrimination: For example, staff members actively respond to discriminatory comments when they encounter them. Claims of discrimination are also considered seriously, regardless of intention. Practice is free of discrimination and differential treatment based on income level and source of income and health benefits. Practice is free of discrimination based on social location, life histories and health challenges such as substance use, experiencing homelessness, poor hygiene or less-typical appearance or behaviours.
  7. Promote community + patient participatory engagement: Patients and community members have an active voice in their care and are encouraged to provide feedback to the organization. Does the organization have deliberate practices to engage patients in planning processes or through a patient committee?
  8. Tailor care, programs and services to histories: Some people may be survivors of multiple forms of violence with traumatic effects, while still experiencing current and ongoing interpersonal violence (including racial violence and intimate partner violence), and ongoing structural violence (such as systemic and organizational racism, absolute poverty, etc.). How well is this reflected in the care and services provided? What is the history with First Nations peoples in that area? How well does your organization know the local context? How well is that reflected in the care and services provided?
  9. Enhance access to social determinants of health: Some aspects of peoples’ everyday lives that have major impacts on health, for example, access to affordable, safe housing, income level above the poverty line (social assistance/disability incomes are not), and interactions in the social world that are respectful, non-stigmatizing, and non-discriminatory. How well do payment policies and practices respond to economic vulnerabilities and the limitations of public policy plans? How are the determinants of health acknowledged as part of treatment and prevention? How are Electronic Medical Records used to document the social determinants of health?
  10. Optimize use of place and space: What messages are reflected in the way the space is designed? Is the space designed to be inclusive of those who typically are marginalized? Would people from priority populations see themselves reflected in the design of the space? Are services located in the neighborhoods where people who are underserved may likely reside? Are transportation issues (including cost) considered?


The 10 strategies provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented health care services when working with marginalized populations, and have broad application to a wide range of settings, contexts and jurisdictions.


The measure does not define a composite or average score, and it has not been validated for use in comparisons between agencies or time periods. It was developed for health care services in Canada.


EQUIP Health Care. Health Equity Toolkit. Accessed 16 August 2017. https://equiphealthcare.ca/toolkit/

EQUIP Health Care. Rate Your Organization: 10 Strategies to Guide Organizations in Enhancing Capacity for Equity-Oriented Health Care. Accessed 24 June 2019. https://equiphealthcare.ca/equip/wp-content/uploads/2018/03/RYO-Mar-23-2018.pdf

Browne, A. J., Varcoe, C., Ford-Gilboe, M., & Wathen, N., on behalf of the EQUIP Research Team. (2015). EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal for Equity in Health, 14(152). doi:10.1186/s12939-015-0271-y

Additional information


Data collection method