An article published in The Lancet reports that there are still wide coverage gaps for important maternal and child health interventions among Countdown countries, even though they have made some progress since 1990. J Ties Boerma (WHO, Geneva, Switzerland) and colleagues from the Countdown 2008 Equity Analysis Group also found that in order to reach Millennium Development Goals (MDG) 4 and 5, the rate of progress would have to be more than doubled.

To reach these conclusions, researchers analyzed household survey data acquired between 1990 and 2006 for 54 Countdown countries. They used the data on four intervention areas – family planning, maternal and newborn care, immunization, and treatment of sick children – to create an aggregate coverage index with each intervention equally weighted.

The coverage gap – the percentage of the population that does not receive treatment coverage – averaged about 43% for the most recent surveys of the 54 countries. Less than 20% of people in Tajikistan and Peru did not receive coverage, and more than 70% in Ethiopia and Chad received no treatment coverage. The researchers also found notable differences in the size of the coverage gap between relatively poor and wealthy countries. The mean coverage gap was 54% for the poorest fifth of the population and 29% for the richest fifth. The differences in between poor and wealthy countries were most pronounced in the maternal and newborn health interventions and smallest in the immunization intervention area.

Forty of the countries had more than one survey and demonstrated a coverage gap decrease by 0.9% per year since the early 1990s. Only three countries after 1995 had coverage gap decreases greater than 2% per year – Cambodia, Mozambique, and Nepal. Lastly, patterns of inequality remained as expected. In countries with lower overall coverage, richer people had high coverage rates; and in countries with higher overall coverage, poorer people had low coverage rates.

“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,” conclude the authors.

Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries
Countdown 2008 Equity Analysis Group
The Lancet (2008). 371[9620]:1259-67.

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Written by: Peter M Crosta