Author:
Wigley A. S.,Tejedor-Garavito N.,Alegana V.,Carioli A.,Ruktanonchai C. W.,Pezzulo C.,Matthews Z.,Tatem A. J.,Nilsen K.
Abstract
Abstract
Background
With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes.
Methods
Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services.
Results
Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other.
Conclusion
While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.
Publisher
Springer Science and Business Media LLC
Reference57 articles.
1. Arts M, Begin F, Chaiban T, Chandy L, Hayashi C, Hereward M, et al. Every child alive. 2018. https://data.unicef.org/wp-content/uploads/2018/02/Every-Child-Alive-report_FINAL-1.pdf. Accessed 27 Sept 2018.
2. Koblinsky M, Moyer CA, Calvert C, Campbell J, Campbell OMR, Feigl AB, et al. Quality maternity care for every woman, everywhere: a call to action. Lancet. 2016;388:2307–20. https://doi.org/10.1016/S0140-6736(16)31333-2.
3. Graham W, Woodd S, Byass P, Filippi V, Gon G, Virgo S, et al. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016;388:2164–75. https://doi.org/10.1016/S0140-6736(16)31533-1.
4. WHO. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2019. https://apps.who.int/iris/handle/10665/327596. Accessed 5 Jun 2020.
5. WHO WB. Tracking Universal Health Coverage: 2017 Global Monitoring Report: executive summary. 2017.
Cited by
38 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献