TY - JOUR
T1 - Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa
AU - Faye, Cheikh Mbacké
AU - Wehrmeister, Fernando C.
AU - Melesse, Dessalegn Y.
AU - Mutua, Martin Kavao Kavao
AU - Maïga, Abdoulaye
AU - Taylor, Chelsea Maria
AU - Amouzou, Agbessi
AU - Jiwani, Safia S.
AU - Da Silva, Inácio Crochemore Mohnsam
AU - Sidze, Estelle Monique
AU - Porth, Tyler Andrew
AU - Ca, Tome
AU - Ferreira, Leonardo Zanini
AU - Strong, Kathleen L.
AU - Kumapley, Richard
AU - Carvajal-Aguirre, Liliana
AU - Hosseinpoor, Ahmad Reza
AU - Barros, Aluisio J.D.
AU - Boerma, Ties
N1 - Funding Information:
funding We are grateful to the Bill and Melinda Gates Foundation for funding provided to the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health through Grant OPP1148933.
Funding Information:
for Women’s, Children’s and Adolescents’ Health and the Partnership for Maternal, Newborn & Child Health (PMNCH) hosted by the World Health Organization and commissioned by The BMJ, which peer reviewed, edited, and made the decisions to publish. Open access fees are funded by the Bill and Melinda Gates Foundation and PMNCH. Competing interests None declared. patient consent for publication Not required.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/1/26
Y1 - 2020/1/26
N2 - 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.
AB - 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.
KW - child health
KW - maternal health
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U2 - 10.1136/bmjgh-2019-002232
DO - 10.1136/bmjgh-2019-002232
M3 - Article
C2 - 32133183
AN - SCOPUS:85078743900
SN - 2059-7908
VL - 5
JO - BMJ Global Health
JF - BMJ Global Health
IS - 1
M1 - e002232
ER -