Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa

Cheikh Mbacké Faye, Fernando C. Wehrmeister, Dessalegn Y. Melesse, Martin Kavao Kavao Mutua, Abdoulaye Maïga, Chelsea Maria Taylor, Agbessi Amouzou, Safia S. Jiwani, Inácio Crochemore Mohnsam Da Silva, Estelle Monique Sidze, Tyler Andrew Porth, Tome Ca, Leonardo Zanini Ferreira, Kathleen L. Strong, Richard Kumapley, Liliana Carvajal-Aguirre, Ahmad Reza Hosseinpoor, Aluisio J.D. Barros, Ties Boerma

Research output: Contribution to journalArticle

Abstract

Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women's, Children's and Adolescent's Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions.

Original languageEnglish (US)
Article numbere002232
JournalBMJ Global Health
Volume5
Issue number1
DOIs
StatePublished - Jan 26 2020

Keywords

  • child health
  • maternal health

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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    Faye, C. M., Wehrmeister, F. C., Melesse, D. Y., Mutua, M. K. K., Maïga, A., Taylor, C. M., Amouzou, A., Jiwani, S. S., Da Silva, I. C. M., Sidze, E. M., Porth, T. A., Ca, T., Ferreira, L. Z., Strong, K. L., Kumapley, R., Carvajal-Aguirre, L., Hosseinpoor, A. R., Barros, A. J. D., & Boerma, T. (2020). Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa. BMJ Global Health, 5(1), [e002232]. https://doi.org/10.1136/bmjgh-2019-002232