Lancet Global Health: Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition

2 May, 2020

Citation, abstract, selected extracts, and comments from me below.

CITATION: Health policy| volume 8, issue 5, e730-e736, may 01, 2020

Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: progress, future prospects, and implications for quality health systems

Andrew D Marsh et al.

Published:May, 2020 The Lancet Global Health

DOI: https://doi.org/10.1016/S2214-109X(20)30104-2

SUMMARY

Intervention coverage — the proportion of the population with a health-care need who receive care — does not account for intervention quality and potentially overestimates health benefits of services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention coverage. Many definitions and methodological approaches to measuring effective coverage have been developed, resulting in confusion over definition, calculation, interpretation, and monitoring of these measures. To develop a consensus on the definition and measurement of effective coverage for maternal, newborn, child, and adolescent health and nutrition (MNCAHN), WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to make recommendations for standardising the definition of effective coverage, measurement approaches for effective coverage, indicators of effective coverage in MNCAHN, and to develop future effective coverage research priorities. Via a series of consultations, the group recommended that effective coverage be defined as the proportion of a population in need of a service that resulted in a positive health outcome from the service. The proposed effective coverage measures and care cascade steps can be applied to further develop effective coverage measures across a broad range of MNCAHN services. Furthermore, advances in measurement of effective coverage could improve monitoring efforts towards the achievement of universal health coverage.

SELECTED EXTRACTS

'Monitoring progress towards achieving universal health coverage requires metrics that capture information on the proportion of the population in need of care that receives health services at a sufficient level of quality to yield the intended health benefits.'

'The Think Tank Group proposed the following adaptation of Amouzou and colleagues' cascade steps and their definitions, with illustrative examples for MNCAHN interventions.

Step 1 is the target population: identifying the population with a specific health need.

Step 2 is service contact coverage: the proportion of the population in need who come into contact with the (relevant) health service.

Step 3 is input-adjusted coverage: the proportion of the population in need who come into contact with a health service that is ready to provide care...

Step 4 is intervention coverage: the proportion of the population in need who come into contact with a service that is ready and that receives the service.

Step 5 is quality-adjusted coverage: the proportion of the population in need who come into contact with a service that is ready and that receives the service according to quality-of-care standards...

Step 6 is user adherence-adjusted coverage: the proportion of the population in need who receives the service according to quality-of-care standards and that adheres to provider instructions...

Step 7 is outcome-adjusted coverage: the proportion of the population in need who receives the service according to quality-of-care standards, adheres to provider instructions, and has the expected health outcome...'

COMMENTS (Neil PW)

I note that several of the Think Tank Group are eminent global health professionals and are members of HIFA, and invite their further thoughts. For example:

1. I s there a need for more flexibility in such cascades? In reality, only a subgroup of patients' experiences with health and illness go through a sequence of steps as defined by the think tank group. The paper notes for example that a pregnant woman in a population (step 1) may not receive any of the steps 2-6, and yet the result may be the desired positive outcome: healthy mother and baby (Step 2).

2. The cascade model doesn't include decisions and behaviour by patients and families with regard to self-care, prevention of illness, health behaviour choices, management of common illnesses, recognition of need to see a health worker... A focus on pre-facility decision making would be empowering to patients and families. (Such a focus could be complementary to the proposed model.)

3. The model lacks focus on the basic needs of health workers. Arguably, a model that ensures that health workers' basic needs are met (Skills, Equipment, Information, Systems support, Medicines, Incentives, Communication) may be more likely to deliver effective health coverage. A focus on health workers could be more dynamically empowering to their ability to deliver the care that they almost universally want to give, and for which they are trained. (Such a focus could be complementary to the proposed model.)

4. The elimination of actual and potential harm. We know from our discussions on HIFA and CHIFA that huge numbers of people are given ineffective and potentially dangerous treatments resulting in avoidable death from common illness. Countless people are not given the right treatment, even where such treatment is readily available. Can the model embrace minimisation of potential for harm?

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org