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Review
. 2019 Jun 24;4(Suppl 4):e001297.
doi: 10.1136/bmjgh-2018-001297. eCollection 2019.

Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage

Agbessi Amouzou  1 , Hannah Hogan Leslie  2 , Malathi Ram  1 , Monica Fox  1 , Safia S Jiwani  1 , Jennifer Requejo  1   3 , Tanya Marchant  4 , Melinda Kay Munos  1 , Lara M E Vaz  5 , William Weiss  1 , Chika Hayashi  3 , Ties Boerma  6
Affiliations
Review

Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage

Agbessi Amouzou et al. BMJ Glob Health. .

Abstract

Current methods for measuring intervention coverage for reproductive, maternal, newborn, and child health and nutrition (RMNCH+N) do not adequately capture the quality of services delivered. Without information on the quality of care, it is difficult to assess whether services provided will result in expected health improvements. We propose a six-step coverage framework, starting from a target population to (1) service contact, (2) likelihood of services, (3) crude coverage, (4) quality-adjusted coverage, (5) user-adherence-adjusted coverage and (6) outcome-adjusted coverage. We support our framework with a comprehensive review of published literature on effective coverage for RMNCH+N interventions since 2000. We screened 8103 articles and selected 36 from which we summarised current methods for measuring effective coverage and computed the gaps between 'crude' coverage measures and quality-adjusted measures. Our review showed considerable variability in data sources, indicator definitions and analytical approaches for effective coverage measurement. Large gaps between crude coverage and quality-adjusted coverage levels were evident, ranging from an average of 10 to 38 percentage points across the RMNCH+N interventions assessed. We define effective coverage as the proportion of individuals experiencing health gains from a service among those who need the service, and distinguish this from other indicators along a coverage cascade that make quality adjustments. We propose a systematic approach for analysis along six steps in the cascade. Research to date shows substantial drops in effective delivery of care across these steps, but variation in methods limits comparability of the results. Advancement in coverage measurement will require standardisation of effective coverage terminology and improvements in data collection and methodological approaches.

Keywords: RMNCH+N; continuum of care; effective coverage; intervention coverage; quality of care; quality-adjusted coverage.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Hypothetical cascade of the potential losses of healthbenefits of interventions among a population in need of a specific healthservice.
Figure 2
Figure 2
Distribution of publications by component of thecontinuum of care.
Figure 3
Figure 3
Average percentage points gap between contact or crudecoverage and adjusted coverage measures.
See this image and copyright information in PMC

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