Anindya Kanya, Marthias Tiara, Vellakkal Sukumar, Carvalho Natalie, Atun Rifat, Morgan Alison, Zhao Yang, Hulse Emily Sg, McPake Barbara, Lee John Tayu
Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.
Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
EClinicalMedicine. 2021 Sep 7;40:101103. doi: 10.1016/j.eclinm.2021.101103. eCollection 2021 Oct.
Reducing socioeconomic inequalities in access to good quality health care is key for countries to achieve Universal Health Coverage. This study aims to assess socioeconomic inequalities in effective coverage of reproductive, maternal, newborn and child health (RMNCH) in low- and middle-income countries (LMICs).
Using the most recent national health surveys from 39 LMICs (between 2014 and 2018), we calculated coverage indicators using effective coverage care cascade that consists of service contact, crude coverage, quality-adjusted coverage, and user-adherence-adjusted coverage. We quantified wealth-related and education-related inequality using the relative index of inequality, slope index of inequality, and concentration index.
The quality-adjusted coverage of RMNCH services in 39 countries was substantially lower than service contact, in particular for postnatal care (64 percentage points [pp], value<0·0001), family planning (48·7 pp, <0·0001), and antenatal care (43·6 pp, <0·0001) outcomes. Upper-middle-income countries had higher effective coverage levels compared with low- and lower-middle-income countries in family planning, antenatal care, delivery care, and postnatal care. Socioeconomic inequalities tend to be wider when using effective coverage measurement compared with crude and service contact measurements. Our findings show that upper-middle-income countries had a lower magnitude of inequality compared with low- and lower-middle-income countries.
Reliance on the average contact coverage tends to underestimate the levels of socioeconomic inequalities for RMNCH service use in LMICs. Hence, the effective coverage measurement using a care cascade approach should be applied. While RMNCH coverages vary considerably across countries, equitable improvement in quality of care is particularly needed for lower-middle-income and low-income countries.
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减少获得优质医疗保健方面的社会经济不平等是各国实现全民健康覆盖的关键。本研究旨在评估低收入和中等收入国家（LMICs）在生殖、孕产妇、新生儿和儿童健康（RMNCH）有效覆盖方面的社会经济不平等。
利用39个低收入和中等收入国家（2014年至2018年期间）的最新全国健康调查，我们使用由服务接触、粗略覆盖、质量调整覆盖和用户依从性调整覆盖组成的有效覆盖护理级联来计算覆盖指标。我们使用不平等相对指数、不平等斜率指数和集中指数来量化与财富和教育相关的不平等。
39个国家的RMNCH服务质量调整覆盖远低于服务接触，特别是产后护理（64个百分点[pp]，值<0.0001）、计划生育（48.7 pp，<0.0001）和产前护理（43.6 pp，<0.0001）结果。与低收入和中低收入国家相比，中高收入国家在计划生育、产前护理、分娩护理和产后护理方面的有效覆盖水平更高。与粗略和服务接触测量相比，使用有效覆盖测量时社会经济不平等往往更大。我们的研究结果表明，与低收入和中低收入国家相比，中高收入国家的不平等程度较低。
依赖平均接触覆盖往往会低估低收入和中等收入国家RMNCH服务使用的社会经济不平等水平。因此，应采用使用护理级联方法的有效覆盖测量。虽然各国的RMNCH覆盖差异很大，但中低收入和低收入国家尤其需要在护理质量方面实现公平改善。
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