Inequalities in effective coverage measures: are we asking too much of the data?

Exley, Josephine; Marchant, Tanya

doi:10.1136/bmjgh-2022-009200

Cited by 2 publications

(2 citation statements)

References 15 publications

(28 reference statements)

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“…Recently, in 2021, with the growing panoply of terms, concepts, and measures, Exley and colleagues conducted rapid systematic reviews of effective coverage and coverage cascades in the literature since 2010 for childbirth, newborn, and child health interventions in low- and middle-income countries [ 18 , 39 ]. They concluded that the definitions of effective coverage differed across 64 reports on effective coverage, and varied with the number of cascade steps used to “adjust” for quality of care and the methods used to generate a composite measure.…”

Section: Resultsmentioning

confidence: 99%

Effective Coverage in Health Systems: Evolution of a Concept

Karim

Savigny

2023

Diseases

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The manner in which high-impact, life-saving health interventions reach populations in need is a critical dimension of health system performance. Intervention coverage has been a standard metric for such performance. To better understand and address the decay of intervention effectiveness in real-world health systems, the more complex measure of “effective coverage” is required, which includes the health gain the health system could potentially deliver. We have carried out a narrative review to trace the origins, timeline, and evolution of the concept of effective coverage metrics to illuminate potential improvements in coherence, terminology, application, and visualizations, based on which a combination of approaches appears to have the most influence on policy and practice. We found that the World Health Organization first proposed the concept over 45 years ago. It became increasingly popular with the further development of theoretical underpinnings, and after the introduction of quantification and visualization tools. The approach has been applied in low- and middle-income countries, mainly for HIV/AIDS, TB, malaria, child health interventions, and more recently for non-communicable diseases, particularly diabetes and hypertension. Nevertheless, despite decades of application of effective coverage concepts, there is considerable variability in the terminology used and the choices of effectiveness decay steps included in the measures. Results frequently illustrate a profound loss of service effectiveness due to health system factors. However, policy and practice rarely address these factors, and instead favour narrowly targeted technical interventions.

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Section: Resultsmentioning

confidence: 99%

Effective Coverage in Health Systems: Evolution of a Concept

Karim

Savigny

2023

Diseases

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“…In such cases, either the summary of the facility’s capacity to provide high-quality care is linked with individual data, or individuals are linked to their reported source of care. Such methods overlook variation in the quality of care both within and between health facilities [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Effective coverage of newborn postnatal care in Ethiopia: Measuring inequality and spatial distribution of quality-adjusted coverage

Gebremedhin,

Dawson,

Hayen

2023

PLoS ONE

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Neonatal health is a significant global public health concern, and the first two days of life are crucial for newborn survival. Most studies on newborn postnatal care have focused on crude coverage measures, which limit the evaluation of care quality. However, evidence suggests a shift towards emphasising effective coverage, which incorporates the quality of care when measuring intervention coverage. This research aimed to assess the effective coverage of newborn postnatal care in Ethiopia while also examining its inequalities and spatial distribution. The study used secondary data from the 2016 Ethiopian Demographic and Health Survey, which was a cross-sectional community-based study. A total weighted sample of 4169 women was used for analyses. We calculated crude coverage, which is the proportion who received a postnatal check within 48 hours of birth and quality-adjusted coverage (effective coverage), which is the proportion who received a postnatal check within 48 hours of birth and reported receipt of 6 or more contents of care provided by health care providers. Concentration index and concentration curves were used to estimate the socioeconomic-related inequalities in quality-adjusted newborn postnatal care. The spatial statistic was analysed by using Arc-GIS. The crude coverage of newborn postnatal care was found to be 13.2%, while the effective coverage was 9%. High-quality postnatal care was disproportionately concentrated among the rich. A spatial variation was found in quality-adjusted coverage of newborn postnatal care across regions. The findings suggest that there is a significant gap in the coverage and quality of postnatal care for newborns across regions in Ethiopia. The low rates of coverage and effective coverage, combined with the concentration of high-quality care among the rich and the spatial variation across regions, highlight the need for targeted interventions and policies to address the inequalities in access to high-quality postnatal care for newborns.

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Inequalities in effective coverage measures: are we asking too much of the data?

Cited by 2 publications

References 15 publications

Effective Coverage in Health Systems: Evolution of a Concept

Effective Coverage in Health Systems: Evolution of a Concept

Effective coverage of newborn postnatal care in Ethiopia: Measuring inequality and spatial distribution of quality-adjusted coverage

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