Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage
Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage
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DOI：
10.1136/bmjgh-2018-001297
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发表时间：
2019-07-01
影响因子：
8.1
通讯作者：
Weiss, Bill
中科院分区：
文献类型：
--
作者：
Amouzou, Agbessi;Leslie, Hannah Hogan;Weiss, Bill
目前衡量生殖、孕产妇、新生儿和儿童健康和营养 (RMNCH+N) 干预覆盖率的方法无法充分反映所提供服务的质量。如果没有有关护理质量的信息，就很难评估所提供的服务是否会带来预期的健康改善。我们提出了一个六步覆盖框架，从目标人群开始到（1）服务联系，（2）服务可能性，（3）粗略覆盖，（4）质量调整覆盖，（5）用户依从性调整覆盖和（6）结果调整覆盖。我们通过对 2000 年以来 RMNCH+N 干预措施有效覆盖范围的已发表文献进行全面审查来支持我们的框架。我们筛选了 8103 篇文章，并从中选择了 36 篇文章，我们总结了当前衡量有效覆盖范围的方法，并计算了“粗略”覆盖措施与质量调整措施之间的差距。我们的审查表明，有效覆盖率测量的数据源、指标定义和分析方法存在很大差异。粗略覆盖率和质量调整覆盖率水平之间的巨大差距是显而易见的，在评估的 RMNCH+N 干预措施中，平均差距为 10 到 38 个百分点。我们将有效覆盖率定义为从服务中获得健康收益的个人在需要该服务的人中所占的比例，并将其与覆盖范围级联中进行质量调整的其他指标区分开来。我们提出了一种系统的方法，可以沿着级联的六个步骤进行分析。迄今为止的研究表明，这些步骤的有效护理服务大幅下降，但方法的变化限制了结果的可比性。覆盖率衡量的进步需要有效覆盖率术语的标准化以及数据收集和方法论的改进。
Current methods for measuring intervention coverage for reproductive, maternal, newborn, and child health and nutrition (RMNCH+N) do not adequately capture the quality of services delivered. Without information on the quality of care, it is difficult to assess whether services provided will result in expected health improvements. We propose a six-step coverage framework, starting from a target population to (1) service contact, (2) likelihood of services, (3) crude coverage, (4) quality-adjusted coverage, (5) user-adherence-adjusted coverage and (6) outcome-adjusted coverage. We support our framework with a comprehensive review of published literature on effective coverage for RMNCH+N interventions since 2000. We screened 8103 articles and selected 36 from which we summarised current methods for measuring effective coverage and computed the gaps between 'crude' coverage measures and quality-adjusted measures. Our review showed considerable variability in data sources, indicator definitions and analytical approaches for effective coverage measurement. Large gaps between crude coverage and quality-adjusted coverage levels were evident, ranging from an average of 10 to 38 percentage points across the RMNCH+N interventions assessed. We define effective coverage as the proportion of individuals experiencing health gains from a service among those who need the service, and distinguish this from other indicators along a coverage cascade that make quality adjustments. We propose a systematic approach for analysis along six steps in the cascade. Research to date shows substantial drops in effective delivery of care across these steps, but variation in methods limits comparability of the results. Advancement in coverage measurement will require standardisation of effective coverage terminology and improvements in data collection and methodological approaches.