Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa

Abstract

Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women’s, Children’s and Adolescent’s Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions.

A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya

“…Constructing SVI COVID-19 disease vulnerability indices have been created using different approaches ranging from technical [50][51][52] to simpler approaches. [53][54][55] In this analysis, the indices were created following approaches used to define universal health coverage (UHC) and equity in maternal and child health, [56][57][58][59][60] infectious disease vulnerability index 61 and some of the recent COVID-19 vulnerability indices. [53][54][55] To create SVI for Kenyan subcounties, three subdomain indices were first defined based on major thematic areas related to COVID-19 vulnerability (table 1 and figure 1).…”

Geospatial estimation of reproductive, maternal, newborn and child health indicators: a systematic review of methodological aspects of studies based on household surveys

“…de Pelotas, Pelotas, Brazil. 3 WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK.…”

“…Despite progress in the area, with the increase in coverage of several indicators, there is yet much to be achieved [ 2 ]. Planning and implementation of essential health interventions, delivered by supporting organizations and governments, is mainly done at small administrative divisions such as districts, states, provinces, regions or counties [ 3 ]. This requires geographically disaggregated information, which enables more precise adjustment of policies and targeting of resources [ 4 ].…”

High Inequality and Slow Services Improvement in Newborn and Child Health Interventions in Ethiopia

“…The main possible reason could be poor people might be spending more time on income making opportunities rather than accessing the services. 13 Health-seeking attitudes and practices of poor and less educated people might also have contributed to the observed inequality. Health facility waiting time and indirect costs which accumulated for travel to immunization centers might be possible factors that could hinder service-seeking behavior, hence leading to inequality.…”

“…5 Despite some improvements in global immunization coverage, there remains considerable regional and local inequalities 2,[6][7][8][9][10][11][12][13][14][15][16] that are due to several reasons such as family-related social and behavioral factors, resources limitation, competing health priorities, poor management, and inadequate monitoring and supervision. 2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Apart from several challenges, inequality in newborn and child health interventions, particularly immunization and vitamin A supplementation, are a major concern impeding developing countries to achieve child health-related desired targets. [15][16][17][18][19] Inequality in childhood immunization can be linked to economic status and mother's education level, place of residence, and child sex.…”