Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
African Population and Health Policy Initiative, Gombe, Nigeria.
Int J Equity Health. 2020 Jun 1;19(1):78. doi: 10.1186/s12939-020-01204-5.
Universal Health Coverage (UHC) remains a critical public health goal that continues to elude many countries of the global south. As countries strive for its attainment, it is important to track progress in various subregions of the world to understand current levels and mechanisms of progress for shared learning. Our aim was to compare multidimensional equity gaps in access to skilled attendant at birth (SAB) and coverage of the third dose of Diphtheria-Tetanus-Pertussis (DTP3) across 14 West African countries.
The study was a cross sectional comparative analysis that used publicly available, nationally representative health surveys. We extracted data from Demographic and Health Surveys, and Multiple Indicator Cluster Surveys conducted between 2010 and 2017 in Benin, Burkina Faso, Cote d' Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo. The World Health Organization's Health Equity Assessment Toolkit (HEAT Plus) software was used to evaluate current levels of intra-country equity in access to SAB and DTP3 coverage across four equity dimensions (maternal education, location of residence, region within a country and family wealth status).
There was a general trend of higher levels of coverage for DTP3 compared to access to SAB in the subregion. Across the various dimensions of equity, more gaps appear to have been closed in the subregion for DTP3 compared to SAB. The analysis revealed that countries such as Sierra Leone, Liberia and Ghana have made substantial progress towards equitable access for the two outcomes compared to others such as Nigeria, Niger and Guinea.
In the race towards UHC, equity should remain a priority and comparative progress should be consistently tracked to enable the sharing of lessons. The West African subregion requires adequate government financing and continued commitment to move toward UHC and close health equity gaps.
全民健康覆盖（UHC）仍然是一个关键的公共卫生目标，许多全球南方国家仍难以实现。随着各国努力实现这一目标，跟踪世界各地区的进展情况以了解共同学习的当前水平和进展机制非常重要。我们的目的是比较 14 个西非国家在获得熟练接生人员（SAB）和第三剂白喉、破伤风、百日咳（DTP3）疫苗接种覆盖率方面的多维公平差距。
这项研究是一项横断面比较分析，使用了公开的、具有代表性的国家卫生调查数据。我们从 2010 年至 2017 年在贝宁、布基纳法索、科特迪瓦、冈比亚、加纳、几内亚、几内亚比绍、利比里亚、马里、尼日尔、尼日利亚、塞内加尔、塞拉利昂和多哥进行的人口与健康调查和多指标类集调查中提取数据。使用世界卫生组织的卫生公平评估工具包（HEAT Plus）软件评估了在 SAB 获得情况和 DTP3 覆盖率的四个公平维度（孕产妇教育、居住地点、国家内区域和家庭财富状况）方面，国家内部的当前公平程度。
该子区域中 DTP3 的覆盖率总体上高于 SAB 的覆盖率。在各种公平维度中，与 SAB 相比，DTP3 在该子区域中似乎已经缩小了更多的差距。分析表明，与其他国家（如尼日利亚、尼日尔和几内亚）相比，塞拉利昂、利比里亚和加纳在实现这两个结果的公平获得方面取得了重大进展。
在实现全民健康覆盖的竞赛中，公平性应仍然是一个优先事项，应持续跟踪比较进展情况，以促进经验共享。西非子区域需要充足的政府资金投入和持续的承诺，以迈向全民健康覆盖并缩小卫生公平差距。
