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Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries.

Alkenbrack S, Chaitkin M, Zeng W, Couture T, Sharma S - PLoS ONE (2015)

Bottom Line: Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage.Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.Equity in RH and MH service coverage has improved but varies considerably across countries and over time.

View Article: PubMed Central - PubMed

Affiliation: Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America.

ABSTRACT

Introduction: Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country's progress, or lack thereof, toward more equitable RH and MH service coverage.

Methods: We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries' progress toward greater equity in RH and MH service coverage.

Results: Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.

Conclusion: Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC).

No MeSH data available.


Equity of reproductive and maternal health service coverage, full sample of countries, 1990–2013.
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pone.0134905.g001: Equity of reproductive and maternal health service coverage, full sample of countries, 1990–2013.

Mentions: Fig 1 shows the global trends in equity of service coverage for four RH and MH indicators. We computed the average concentration index for each indicator across five time periods, prompting a handful of basic observations. First, relative equity of coverage for all four services has improved substantially and continually, except for a stalling of progress in the early 2000s for facility delivery. This time period coincides with the implementation of user fees in many countries, particularly in Africa, and may be a reflection of the reduced utilization of health services that was documented in multiple countries following that change [33–35]. Given the large number of African countries in our sample, this trend may be influencing the overall trends in the sample. While Fig 1 does not show changes in absolute equity, absolute equity has also improved during this time period.


Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries.

Alkenbrack S, Chaitkin M, Zeng W, Couture T, Sharma S - PLoS ONE (2015)

Equity of reproductive and maternal health service coverage, full sample of countries, 1990–2013.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4558013&req=5

pone.0134905.g001: Equity of reproductive and maternal health service coverage, full sample of countries, 1990–2013.
Mentions: Fig 1 shows the global trends in equity of service coverage for four RH and MH indicators. We computed the average concentration index for each indicator across five time periods, prompting a handful of basic observations. First, relative equity of coverage for all four services has improved substantially and continually, except for a stalling of progress in the early 2000s for facility delivery. This time period coincides with the implementation of user fees in many countries, particularly in Africa, and may be a reflection of the reduced utilization of health services that was documented in multiple countries following that change [33–35]. Given the large number of African countries in our sample, this trend may be influencing the overall trends in the sample. While Fig 1 does not show changes in absolute equity, absolute equity has also improved during this time period.

Bottom Line: Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage.Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.Equity in RH and MH service coverage has improved but varies considerably across countries and over time.

View Article: PubMed Central - PubMed

Affiliation: Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America.

ABSTRACT

Introduction: Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country's progress, or lack thereof, toward more equitable RH and MH service coverage.

Methods: We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries' progress toward greater equity in RH and MH service coverage.

Results: Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.

Conclusion: Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC).

No MeSH data available.