Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa
Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/1/e002232.full |
| _version_ | 1797260174370537472 |
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| author | Inácio Crochemore Mohnsam da Silva Aluísio J D Barros Ties Boerma Fernando C Wehrmeister Leonardo Zanini Ferreira Ahmad Reza Hosseinpoor Liliana Carvajal-Aguirre Abdoulaye Maïga Safia S Jiwani Tyler Andrew Porth Chelsea Maria Taylor Dessalegn Y Melesse Kathleen L Strong Cheikh Mbacké Faye Agbessi Amouzou Martin Kavao Kavao Mutua Estelle Monique Sidze Tome Ca Richard Kumapley |
| author_facet | Inácio Crochemore Mohnsam da Silva Aluísio J D Barros Ties Boerma Fernando C Wehrmeister Leonardo Zanini Ferreira Ahmad Reza Hosseinpoor Liliana Carvajal-Aguirre Abdoulaye Maïga Safia S Jiwani Tyler Andrew Porth Chelsea Maria Taylor Dessalegn Y Melesse Kathleen L Strong Cheikh Mbacké Faye Agbessi Amouzou Martin Kavao Kavao Mutua Estelle Monique Sidze Tome Ca Richard Kumapley |
| author_sort | Inácio Crochemore Mohnsam da Silva |
| collection | DOAJ |
| description | Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women’s, Children’s and Adolescent’s Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions. |
| first_indexed | 2024-04-24T23:21:08Z |
| format | Article |
| id | doaj.art-f1f6d229d2014c1eb64a0291323e0d00 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-04-24T23:21:08Z |
| publishDate | 2020-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-f1f6d229d2014c1eb64a0291323e0d002024-03-16T08:35:08ZengBMJ Publishing GroupBMJ Global Health2059-79082020-01-015110.1136/bmjgh-2019-002232Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan AfricaInácio Crochemore Mohnsam da Silva0Aluísio J D Barros1Ties Boerma2Fernando C Wehrmeister3Leonardo Zanini Ferreira4Ahmad Reza Hosseinpoor5Liliana Carvajal-Aguirre6Abdoulaye Maïga7Safia S Jiwani8Tyler Andrew Porth9Chelsea Maria Taylor10Dessalegn Y Melesse11Kathleen L Strong12Cheikh Mbacké Faye13Agbessi Amouzou14Martin Kavao Kavao Mutua15Estelle Monique Sidze16Tome Ca17Richard Kumapley18International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, BrazilInternational Centre for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, BrazilRady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada6 Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, BrazilInternational Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, BrazilDivision of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, SwitzerlandData and Analytics Section, UNICEF, New York, New York, USAInternational Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAInternational Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAUNICEF, New York City, New York, USADepartment of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, SwitzerlandCountdown to 2030 for Women`s, Children`s and Adolescents` Health, Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, SwitzerlandWest Africa Regional Office, African Population and Health Research Center, Dakar, SenegalDepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAAfrican Population and Health Research Center, Nairobi, KenyaAfrican Population and Health Research Center, Nairobi, KenyaWest African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina FasoUNICEF, New York City, New York, USASubnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women’s, Children’s and Adolescent’s Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions.https://gh.bmj.com/content/5/1/e002232.full |
| spellingShingle | Inácio Crochemore Mohnsam da Silva Aluísio J D Barros Ties Boerma Fernando C Wehrmeister Leonardo Zanini Ferreira Ahmad Reza Hosseinpoor Liliana Carvajal-Aguirre Abdoulaye Maïga Safia S Jiwani Tyler Andrew Porth Chelsea Maria Taylor Dessalegn Y Melesse Kathleen L Strong Cheikh Mbacké Faye Agbessi Amouzou Martin Kavao Kavao Mutua Estelle Monique Sidze Tome Ca Richard Kumapley Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa BMJ Global Health |
| title | Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa |
| title_full | Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa |
| title_fullStr | Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa |
| title_full_unstemmed | Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa |
| title_short | Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa |
| title_sort | large and persistent subnational inequalities in reproductive maternal newborn and child health intervention coverage in sub saharan africa |
| url | https://gh.bmj.com/content/5/1/e002232.full |
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