The Effective Coverage Data Analysis Center, based at Johns Hopkins Bloomberg School of Public Health, develops analytical tools to permit the estimation and analysis of readiness and quality-adjusted coverage of reproductive, maternal, newborn and child health and nutrition (RMNCH-N) interventions in low and middle-income countries.

The center collaborates with other Countdown centers and countries to access and harmonize household and health facility surveys and routine health information system datasets for the analysis, and support capacity strengthening at country level for the analysis.

The coverage of an intervention is defined as the proportion of the population in need of the intervention that receives it. Effective coverage is defined as the “proportion of individuals experiencing optimal health gains from a service among those who need the service”. While it is essential to monitor coverage to assess progress toward universal health coverage, there is increasing evidence indicating that coverage defined and measured as such is insufficient to account for the full benefit on population health. There are numerous cases where high and near universal coverage coexist with high prevalence of adverse outcomes. For example, high coverage of antenatal care and skilled birth attendance occur with high levels of intrapartum stillbirth and early neonatal mortality in many countries. Therefore, understanding the structural readiness and the quality of services provided with the health system is critical to assessing whether the expected health benefits from health interventions are achieved.

Data sources for measuring effective coverage include:

When household surveys are linked to the health facility surveys, quality-adjusted measures can be estimated.

This webinar explained the concept of effective coverage and how to conduct this analysis using available datasets and code.


Background Resources

The cascade for effective coverage measurement has been developed by Countdown to organize measures of quality-adjusted coverage, showing the loss of health benefit at each stage.  The cascade published in 2018 was adapted by the World Health Organization in 2020.

Countdown published a series of articles on improving coverage measurement, including several papers that linked household surveys and health facility survey data to estimate quality adjusted coverage.



Datasets analysis code will be shared via a GitHub repository

This spreadsheet was developed by the Countdown to 2030 Data & Analysis Center for Effective Coverage at Johns Hopkins University to map out availability, readiness and process quality indicators collected in Service Provision Assessments (SPA) and Service Availability and Readiness Assessment surveys (SARA). It is organized into three sheets based on type of quality of care indicators: structural quality-service availability, structural quality-service readiness, and process quality indicators. The indicators are categorized by domains, subdomains as well as area of care: family planning, sexual health, antenatal care, labor and delivery care, postnatal care, malaria, tuberculosis, immunization, child care, nutrition and adolescent health.


In this one-hour webinar, Agbessi Amouzo, Aboudalaye Maiga, Elizabeth Hazel, Safia Jiwani, Emily Wilson, and Melinda Munos from the Institute for International Programs at the Johns Hopkins Bloomberg School of Public Health explain the concept of effective coverage as it applies to maternal, newborn, adolescent and child health and nutrition services. Although presented as in internal webinar for Countdown to 2030 partner organizations, it may be of interest other health researchers and evaluators who are interested in how to apply this concept and would like to access available resources.

This webinar presented an overview of a supplement published in the Journal of Global Health titled "Measuring and Monitoring Coverage and Quality of Care in Low and Middle Income Countries".


In this one and a half hour webinar, presenters Melinda Munos, and Ashley Scheffel, and moderator Cindy Stanton discuss measuring effective coverage. The methodology of measuring effective coverage overall is covered in the first part, and the measuring of coverage for antenatal care is covered in the second half of the webinar. The full recording is available on the Improve Website, as well as the presentation slides.

In this three and a half hour session, quality-adjusted coverage and the ways this can be used to to improve the health of women, children, and adolescents was discussed. This session was a part of the 7th Global Symposium on Health Systems Research in November 2022, held in Bogota, Columbia. The recording of the satellite session is now available below.

Agbessi Amouzou
Safia Jiwani
Emily Wilson
Elizabeth Hazel
Abdoulaye Maïga
Roland Mady