Methods for calculating effective coverage, which is also called quality-adjusted coverage, continue to be refined, and this approach is increasingly being used to inform country-level decision-making. The recording of a satellite session titled, “Measuring effective coverage and quality of care to improve the health of women, children, and adolescents in low and middle income countries”, which took place at the 7th Global Symposium on Health Systems Research in November 2022, is now available on the Countdown YouTube channel. Countdown hosted this session in partnership with the IMPROVE project.
The session included summaries of the methods, case studies from Kenya and Tanzania, a small group practice exercise, and a panel discussion.
Effective coverage methods have been developed because many standard reproductive, maternal, newborn, child and adolescent health indicators only measure contact with the health system, not the quality of services received. Effective coverage estimates are derived from combining household survey data, such as the Demographic Health Surveys, with other data sources, such as Service Provision Assessment surveys.
“Intervention coverage is something that is useful,” said Melinda Munos, an assistant professor at the Johns Hopkins Bloomberg School of Public Health. “It is primarily measured through household surveys, and household surveys aren’t really designed to capture service quality. Effective coverage aims to incorporate quality to better understand what proportion of individuals, which individuals are receiving services with sufficient quality to see a health gain.”
During the panel discussion, Helen Kiarie, head of the Division of Monitoring & Evaluation at the Ministry of Health in Kenya, said that effective coverage estimates shed light on why many coverage indicators have shown increases yet some health outcomes, such as maternal mortality, have shown little or no decline. She said that it also matched her own observations within the health system.
“As much as we are telling mothers to come to the health facilities, we are still having crowded health facilities,” Kairie said. These conditions, plus other demotivating factors such as low wages, leave health care workers unable to provide high quality care for mothers. Kairie said that her team eventually would like to be able to monitor annual trends in effective coverage using the routine health system’s DHIS2 data.
Lara Vaz, technical director for the USAID Momentum Knowledge Accelerator, which is led by the Population Reference Bureau, said effective coverage findings are most helpful when triangulated with other data sources. “It’s an additional piece of information that needs to be used with other pieces of information,” Vaz said. “It’s really important to look at that within the context of your health system and your health service delivery.”
Learn more about Countdown’s Effective Coverage Data & Analysis Center.