Operationalising Equity: The FAIR Approach for Advancing Universal Health Coverage

Abstract Background: Despite the Sustainable Development Goal commitment to 'leave no one behind', health inequalities remain pervasive. Existing frameworks offer little guidance on operationalising equity within health programmes, especially in low-resource settings.Methods: We present the FAIR approach—Find, Analyse, Interview & survey, Randomise—a stepwise, field-tested method for identifying underserved groups, understanding barriers to care, co-developing solutions, and evaluating interventions through embedded pragmatic trials.Findings: Developed through a five-year collaboration across four countries (Botswana, India, Kenya, Nepal), FAIR integrates routine data analysis, participatory inquiry, and adaptive experimentation. It has identified context-specific barriers to access, enabled rapid co-design of solutions, and demonstrated effectiveness through embedded trials. The approach has also been applied to other services including cervical cancer screening in the UK.Conclusion: FAIR provides a practical and replicable model for embedding equity into service delivery. It supports the design of socially accountable, data-driven, and people-centred health systems by building equity-enhancing feedback loops directly into programme processes. The approach may assist health systems in translating equity goals into concrete, context-specific actions, and in generating locally grounded evidence to inform continuous improvement.