Evaluations of effective coverage of maternal and child health services: A systematic review

Abstract

Conventionally used coverage measures do not reflect the quality of care. Effective coverage assesses the extent to which health care services deliver potential health gains to the population by integrating concepts of utilization, need, and quality. We aimed to conduct a systematic review of studies evaluating effective coverage of maternal and child health services, quality measurement strategies, and disparities across wealth quantiles. A systematic search was performed in six electronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Maternity and Infant Care) and grey literature. We also undertook a hand search of references. We developed search terms having no restrictions based on publication period, country, or language. We included studies, which reported effective coverage estimates based on the World Health Organization framework of measuring effective coverage. Twenty-seven studies, all from low and middle-income settings (49 countries), met the criteria and were included in the narrative synthesis of the results. Maternal and child health intervention(s) and program(s) were assessed either at an individual level or as an aggregated measure of health system performance, or both. The effective coverage ranged from 0% for postpartum care to 95% for breastfeeding. When crude coverage measures were adjusted to account for the quality of care, the effective coverage values turned lower. The gap between crude coverage and effective coverage was as high as 86%, and it signified a low quality of care. The assessment of quality of care addressed structural, process, and outcome domains, individually or combined. The wealthiest 20% had higher effective coverage of services than the poorest 20%, an inequitable distribution of coverage. More efforts are needed to improve the quality of maternal and child health services and to eliminate the disparities. Moreover, considering multiple dimensions of quality and the use of standard measurements are recommended to monitor coverage effectively.

Effective coverage of newborn postnatal care in Ethiopia: Measuring inequality and spatial distribution of quality-adjusted coverage

“…The quality dimensions considered, or the selection of indicators determine the effective coverage estimate. However, quality is a multidimensional, complex construct with few standardized and validated measures [ 9 ].…”

“…Research on the effective coverage of newborn postnatal care is limited [9]. Most of the studies conducted in Ethiopia concerning newborn postnatal care focused on crude coverage [38][39][40][41].…”

“…In contrast, effective coverage combines utilisation of health services with the quality of care received, providing a proxy measure of potential health gains from using the services [ 8 ]. Although assessing quality is the most challenging aspect of estimating effective coverage, integrating content of care into crude coverage measures has been proposed as one approach to determining quality-adjusted coverage [ 9 ]. While data collected through DHS do not contain the full recommended list of services or important clinical actions, they provide an indication of care provided at service delivery sites (content of care), at a basic level, as a proxy for quality of care.…”

Analysis of Needs and Weaknesses of The Maternal and Child Health Surveillance System

“…Even though it has experienced a significant decline with the improvement in the Indonesian economy after the crisis, the prevalence of pregnant women's lack of calorie energy is still quite high, namely 16.7%. [2] [3] This incident is further exacerbated by the high mortality rate of children aged one to 5 years, the number of infectious diseases, and the high frequency of investment in worms compared to protein-calorie deficiency and vitamin A deficiency, as well as the rate of malnutrition in pregnant women [4] [5] which contributes to the high rate of low birth weight in Indonesia, therefore the Maternal and Child Health Agency must pay more attention to this age group and convince parents that regular supervision of children aged 1-5 years is as important as supervision of babies. [6] [7] In connection with this, mothers and their families as well as other communities, presented as objects, must also be included as subjects in government health efforts, they as potential in society must be included in the efforts of the Maternal and Child Health Agency, so that efforts are optimal.…”

Quality adjusted coverage of family planning services in low- and middle-income countries: Analysis of 33 countries using Demographic and Health Survey data

“…Improved metrics known as effective coverage indicators measure the proportion of a population in need who receive quality health services, capturing elements of need, use, and quality [ 7 – 9 ]. In many low-and-middle-income countries (LMICs), there is evidence of a significant gap between coverage and effective coverage, indicating a substantial lack of quality services during contact with the health system [ 10 , 11 ].…”