Despite most Countdown countries having made gradual progress since 1990, coverage gaps for key interventions in maternal and child health remain wide. Further, the pace of progress must be more than doubled to reach levels of coverage needed to reach MDG4 and MDG5. These are the conclusions of an Article in this week's Countdown Special Edition of The Lancet.
Ties Boerma, WHO, Geneva, Switzerland, and colleagues from the Countdown 2008 Equity Analysis Group looked at data from household surveys between 1990 and 2006 for 54 countries in the Countdown initiative to create an aggregate coverage index based on four intervention areas: family planning*, maternal and newborn care**, immunisation***, and treatment of sick children**** -- with each given equal weight.
They found that the overall size of the coverage gap (the percentage of the population not receiving treatment coverage) ranged from less than 20% in Tajikistan and Peru to more than 70% in Ethiopia and Chad, with a mean of 43% for the most recent surveys in the 54 countries. There were also large differences within countries, with a country mean coverage gap of 54% for the poorest quintiles of the population and 29% for the wealthiest. These rich/poor differences were largest in the maternal and newborn health intervention area and smallest for immunisation.
In 40 countries with more than one survey, the coverage gap has decreased by an average 0.9% per year since the early 1990s. Declines greater than 2% per year were seen in only three countries post-1995: Cambodia, Mozambique, and Nepal. Inequality patterns remained consistent, with the high coverage for rich people in countries with the lower overall coverage, and low coverage for poor people in the countries with higher overall coverage, remaining more or less the same.
The authors conclude: "Most countdown countries have made gradual progress in reducing the coverage gap for key interventions since 1990. The coverage gaps, however, are still very wide and the pace of decline needs to be more than doubled to make significant progress in the years between now and 2015 to reach levels of coverage of these and other interventions needed for MDG4 and 5."
Notes to editors:
*Family Planning: incorporates family planning and contraception
**Maternal and newborn care: Skilled birth attendance and antenatal care
***Immunisation: against measles, diphtheria, pertussis, tetanus, BCG
****Treatment for sick children: incorporates oral rehydration therapy and treatment of acute respiratory infection
For full definitions, see p1260 table 1 of full Article
Ties Boerma, Department of Measurement and Health Information, WHO, Geneva, Switzerland, T) +41 79 217 3426 E) boermat@who.int (not attending press conference
Jennifer Bryce, Johns Hopkins School of Public Health, Baltimore, USA T) +1 607 280 4800 E) jbrycedanby@aol.com (attending press conference)
Jessie Malter, UNICEF Media Relations, New York, USA T) +1 212 326 7412 / +1 646 732 0047 (mobile) E) jmalter@unicef.org
http://www.eurekalert.org/jrnls/lance/pdfs/Countdownmindthegapfinal.pdf
Journal
The Lancet