Academic journal article Bulletin of the World Health Organization

Summary Indices for Monitoring Universal Coverage in Maternal and Child Health Care/ Indices Synthetiques Pour le Suivi De la Couverture Universelle En Matiere De Sante Maternelle et Infantile/ Indices De Resumen Para El Control De la Cobertura Universal En Atencion Sanitaria Materna E Infantil

Academic journal article Bulletin of the World Health Organization

Summary Indices for Monitoring Universal Coverage in Maternal and Child Health Care/ Indices Synthetiques Pour le Suivi De la Couverture Universelle En Matiere De Sante Maternelle et Infantile/ Indices De Resumen Para El Control De la Cobertura Universal En Atencion Sanitaria Materna E Infantil

Article excerpt

Introduction

Reproductive, maternal, newborn and child health were important elements of the millennium development goals (MDGs). MDG 4 targeted the reduction of child mortality, while MDG 5 focused on the improvement of maternal health. (1) Because most low- and middle-income countries failed to reach the targets of the MDGs by 2015, (2) maternal, newborn and child health goals remained as sustainable development goals (SDGs) 3.1 and 3.2, to be achieved by 2030. Also relevant to the health of mothers and children are SDG 3.7 on sexual and reproductive health and SDG 3.8 on universal health coverage. (3)

Monitoring the coverage of interventions in maternal and child health continues to be central to assessing progress towards development goals. (4) Our experience with the Countdown to 2015 initiative (which tracks progress in interventions in 75 countries) is directly relevant to monitoring the four SDGs mentioned above. (4,5) Starting with 35 coverage indicators monitored in 2005, (6) the Countdown list grew to 73 indicators by 2015. (5) Reporting separately on each indicator proved to be useful at the country and global level for tracking progress, evaluating programmes and planning future actions. However, reporting on tens of indicators generated an overwhelming amount of data and failed to provide a comprehensive picture of progress in scaling up essential health interventions. Recent calls have been made for a focus on a small number of indicators for reporting trends in intervention coverage. (7) To address these needs, the Countdown team has experimented with two summary measures of coverage: the composite coverage index and the co-coverage index.

Both indices comprise eight indicators of coverage of reproductive, maternal, newborn and child health care, with five indicators in common. The composite coverage index was first proposed in 2008 as the weighted average coverage of eight preventive and curative interventions received along the continuum of maternal and child care. (8,9) The index is calculated at group level, either for a whole country or by subgroups such as wealth quintiles or geographical regions. The co-coverage indicator, proposed in 2005, is a simple count of how many preventive interventions are received by individual mother-child pairs, out of a set of eight interventions. (10) Co-coverage is limited to preventive interventions that are recommended for every child and pregnant woman to achieve universal health coverage. Because curative interventions are only required for children who are ill, these are not included in the co-coverage index, for which the denominator includes all children.

Universal health coverage is defined in terms of access to and receipt of essential interventions, and of financial risk protection. In this study we describe and compare the characteristics of the composite coverage index and the co-coverage index for monitoring universal health coverage in reproductive, maternal, newborn and child care. In-depth analyses aimed to: (i) correlate the summary indices with each other and with outcome indicators of mortality and undernutrition; (ii) demonstrate how the summary indices may be used to compare different countries and to monitor within-country socioeconomic inequalities in health coverage; and (iii) to assess how summary indices may be affected by the choice of component indicators.

Methods

Data sources

The database used for the study (11) is generated by the International Center for Equity in Health, Pelotas, Brazil. It includes all the demographic and health surveys (DHS; http://www. dhsprogram.com) and multiple indicau tor surveys (MICS; http://mics.unicef. org) carried out in low- and middleincome countries for which the data sets are publicly available. We used data from DHS phases 3 to 6 (since 1993) and MICS rounds III and IV (since 2005). More details of our approach to analysis of coverage is summarized elsewhere. …

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