More work needed to ensure equity in access

Troy Jacobs, Senior Medical Advisor in USAID’s Office of Maternal-Child Health and Nutrition

The new 2017 report from Countdown 2030 (CD2030) has interesting implications for health research in maternal and child health and nutrition. For one, I’m pleased that more data is available on key drivers of reproductive, maternal, newborn and child health. The data is from 81 ‘priority’ countries which together account for 95% of maternal deaths and 90% of deaths among children under age five.

More data is now available in women’s health–including on modern method use for family planning and skilled birth attendants–and in infant health– including postnatal care for babies, diphtheria, tetanus and pertussis immunization, and exclusive breastfeeding.

The new data shows significant changes (improvement in some cases) in causes of maternal and child deaths; the nutritional status of women, children and adolescent girls; intervention coverage across the continuum of care; and inequalities in intervention coverage.

Critically, a number of these findings have direct implications for the implementation science research agenda forwarded by the Health Research Program (HRP). HRP can build on this new data and learning and support research to catalyze new practices.

The seven key coverage indicators are: - demand for family planning satisfied with modern methods (among married women), - skilled birth attendant, - postnatal care for babies, - exclusive breastfeeding (6 months), - diphtheria-tetanus-pertussis immunization (three doses), - oral rehydration salts treatment for diarrhoea and population using basic drinking-water services Source: United Nations Children’s Fund global database, July 2017, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.
The seven key coverage indicators are:
Modern method use (among married women)
Skilled birth attendant Postnatal care for babies
Exclusive breastfeeding (6 months)
DPT (three doses)
ORT for diarrhea
Population using basic drinking-water services

Source: UNICEF, July 2017. Based on DHS, MICS and other national surveys.

Key Takeways

Equitable access to services remains a huge problem.

For example, in 13 CD 2030 countries in Sub-Saharan Africa the median likelihood of women receiving critical interventions during antenatal visits was below 20%.

We must improve data monitoring on the demographics of those who are underserved, and of service quality

Improving the availability of such data would enhance targeted service delivery, and this more generalizable data could be understood by a wider audience. This coverage data could be used to inform resource allocation for various interventions that have a real impact on maternal and child health outcomes.

The road toward universal health coverage is long

despite significant progress towards increasing coverage of RMNCH interventions. Available evidence shows that services are often of poor quality.

Weak country health systems and conflict situations inhibit the roll-out of new interventions.

For example, only 43% of CD 2030 countries have a national plan for maternal, newborn and child health with a plan for resource allocation.As a result, interventions that are introduced are often not of high quality.

CD2030 is a network of international organizations conducting M&E and implementation research, developing the next generation of maternal and child health researchers. Its main goal is to track coverage levels for reproductive, maternal, newborn and child health interventions (RMNCH); calling on governments and partners for more accountability; identifying knowledge gaps; and proposing new initiatives to achieve women and child health coverage.