Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries

Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5. This research used data from 54 Countdown countries between 2000 and 2008 to examine the inequalities in maternal, newborn and child health interventions differ by both intervention and country.The researchers categorised the data by wealth as measured by possession of assets. Based on wealth, they examined the levels of coverage for 12 maternal, newborn and child health interventions in each country. Based on the analysis, countries were given a composite coverage index, a score that provides an overall indicator of coverage of all interventions assessed.The main findings included that the coverage of skilled birth attendant was the least equitable intervention, followed by four or more antenatal care visits. They also found that interventions that were community rather than facility based were more equitably delivered.Importantly, they found that for all the interventions, the variation in coverage was larger for the poorest people than for richest people. Each of the 54 countries were ranked based on the overall intervention coverage scores- the lower the score, the higher the inequality in coverage. Of the MamaYe countries, Nigeria and Ethiopia were amongst the countries in the study where interventions were most inequitable with the lowest.  All of the MamaYe countries are shown below, alongside the countries with the highest and lowest scores:Country           Ranking by coverage scoreChad                  1Nigeria              2Ethiopia             4Ghana                28Sierra Leone       31Tanzania            36                   Malawi               52Uzbekistan        54The authors recommend that the interventions with most inequitable coverage need to receive attention so ensure that all social groups can access them. Those Interventions which must be provided in a health facility need to also have strategies to ensure that the poorest people can access them.The authors identified several approaches that have improved equity; these include:

• deployment of services and health workers in the areas most in need
• task shifting
• reductions in financial barriers to access to services
• conditional cash transfers

To read the article, click here. Free subscription is required to access the full article. To find out more about Countdown to 2015, click here.Barros A., Ronsmans C., Axelson H., Loaiza E., Bertoldi A.D., França G., Bryce J., Boerma J.T., V. C. (2012). Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. The Lancet, 379(9822), 1225–1233.