Equity and Coverage in the Continuum of Reproductive, Maternal, Newborn and Child Health Services in Nepal-Projecting the Estimates on Death Averted Using the LiST Tool

Abstract

Introduction The third Sustainable Development Goal, focused on health, includes two targets related to the reduction in maternal, newborn and under-five childhood mortality. We found it imperative to examine the equity and coverage of reproductive, maternal, newborn and child health (RMNCH) interventions from 2001 to 2016 in Nepal; and the death aversion that will take place during the SDG period. Methods We used the datasets from the Nepal Demographic Health Surveys (NDHS) 2001(NDHS) , 2006(NDHS) , 2011(NDHS) and 2016. We calculated the coverage and equity for RMNCH interventions and the composite coverage index (CCI). Based on the Annualized Rate of Change (ARC) in the coverage for selected RMNCH indicators, we projected the trend for the RMNCH interventions by 2030. We used the Lives Saved Tools (LiST) tool to estimate the maternal, newborn, under-five childhood deaths and stillbirths averted. We categorised the interventions into four different patterns based on coverage and inequity gap. Results Between 2001 and 2016, a significant improvement is seen in the overall RMNCH intervention coverage-CCI increasing from 46 to 75%. The ARC was highest for skilled attendance at birth (11.7%) followed by care seeking for pneumonia (8.2%) between the same period. In 2016, the highest inequity existed for utilization of the skilled birth attendance services (51%), followed by antenatal care (18%). The inequity gap for basic immunization services reduced significantly from 27.4% in 2001 to 5% in 2016. If the current ARC continues, then an additional 3783 maternal deaths, 36,443 neonatal deaths, 66,883 under-five childhood deaths and 24,024 stillbirths is expected to be averted by the year 2030. Conclusion Nepal has experienced an improvement in the coverage and equity in RMNCH interventions. Reducing inequities will improve coverage for skilled birth attendants and antenatal care. The current annual rate of change in RMNCH coverage will further reduce the maternal, neonatal, under-five childhood deaths and stillbirths.

Lessons from the field: progress towards the sustainable development goals in Nepal in federal transition of the state

“…The under-five mortality reduced from 146 per 1000 live births to 42 per 1000 live births, and the maternal mortality ratio reduced by more than half between 1990 and 2015 1. More than 85% of the children were fully vaccinated as per national schedule in 2015 2. However, the progress was not uniform and disparities were considerable across different social, economic and geographical population groups.…”

“…However, the progress was not uniform and disparities were considerable across different social, economic and geographical population groups. A large inequity gap was witnessed in skilled attendance at birth between the wealthiest and poorest families in 20162 (figure 1). The coverage of skilled attendance at birth was more than 90% among the women from the wealthiest families, but less than 40% among the women from the poorest families.…”

Learning from Nepal’s Progress to Inform the Path to the Sustainable Development Goals for Health, Leaving No-One Behind

“…If Nepal's current trends continue, the poorest group will not attain the 2030 SDG for newborns until 40 years too late (Kc et al 2019a, b, c). Increased focus on these poorest families is required for the health and survival of women and their newborns (Thapa et al 2019). Inequalities for antenatal care and skilled birth attendance have widened.…”

“…(2) providing Universal Health Coverage (UHC), with high quality care, especially at birth; (3) going beyond survival and (4) reaching beyond health through multi-sectoral collaboration (Budhathoki et al 2019a, b;Gurung et al 2019;Kc et al 2019a, b, c;Sunny et al 2019;Thapa et al 2019).…”

Impact of Free Newborn Care Service package on Out of Pocket Expenditure-Evidence from a multicentric study in Nepal.

“…With increase in utilization of maternal and newborn care in last 20 years and with more than 60% of deliveries now taking place in health facility, there is a need for specialized care for sick newborn in Nepal [18]. However, specialized care often coincides with longer hospital stays, signi cantly impacting the cost of neonatal care which puts great nancial burden onto parents [19,20].…”