Measuring universal health coverage in reproductive, maternal, newborn and child health: An update of the composite coverage index

Abstract

Background Monitoring universal health coverage in reproductive, maternal and child health requires appropriate indicators for assessing coverage and equity. In 2008, the composite coverage index (CCI)-a weighted average of eight indicators reflecting family planning, antenatal and delivery care, immunizations and management of childhood illnesses-was proposed. In 2017, the CCI formula was revised to update the family planning and diarrhea management indicators. We explored the implications of adding new indicators to the CCI. Methods We analysed nationally representative surveys to investigate how addition of early breastfeeding initiation (EIBF), tetanus toxoid during pregnancy and post-natal care for babies affected CCI levels and the magnitude of wealth-related inequalities. We used Pearson's correlation coefficient to compare different formulations, and the slope index of inequalities [SII] and concentration index [CIX] to assess absolute and relative inequalities, respectively. Results 47 national surveys since 2010 had data on the eight variables needed for the original and revised formulations, and on EIBF, tetanus vaccine and postnatal care, related to newborn care. The original CCI showed the highest average value (65.5%), which fell to 56.9% when all 11 indicators were included. Correlation coefficients between pairs of all formulations ranged from 0.93 to 0.99. When analysed separately, 10 indicators showed higher coverage with increasing wealth; the exception was EIBF (SII =-2.1; CIX =-0.5). Inequalities decreased when other indicators were added, especially EIBF-the SII fell from 24.8 pp. to 19.2 pp.

Exploring socioeconomic inequalities in maternal and child health coverage in Latin America and the Caribbean

“…The results of this study should be interpreted in the context of each country, so they should be taken with caution. Despite the limitations, our ndings are based on the best method to explore gaps in care coverage between rich and poor [28].…”

Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean

“…The CCI is a weighted score based on aggregate estimates of eight essential interventions for the continuum of care for women and children, from before pregnancy to delivery, the immediate postnatal period, and childhood [ 7 , 15 ]. The index is calculated using the formula: where DFPS = satisfied demand for modern family planning methods; ANC4 = prenatal care (at least four visits); SBA = deliveries attended by qualified personnel; BCG = one dose of Bacillus Calmette-Guérin vaccine; DPT3 = three or more doses of diphtheria-tetanus-pertussis vaccine; MCV = at least one dose of measles vaccine; ORS = children with diarrhea receiving oral rehydration therapy and continuous feeding; NSCLC = children with pneumonia symptoms taken to a health center [ 16 ].…”

“…The CCI is a weighted score based on aggregate estimates of eight essential interventions for the continuum of care for women and children, from before pregnancy to delivery, the immediate postnatal period, and childhood [7,15]. The index is calculated using the formula:…”

Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean

“…HEAT performs health inequality measures calculations from the WHO Health Equity Monitor Database [14]. The database includes data from Demographic The CCI is a weighted score based on aggregate estimates of eight essential interventions for the continuum of care for women and children, from before pregnancy to delivery, the immediate postnatal period, and childhood [7,15]. The index is calculated using the formula:…”