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A paper linking household and facility-level data sources to estimate the effective coverage of facility-based childbirth care.

Estimating effective coverage of childbirth care requires linking population based data sources to health facility data. For effective coverage to gain widespread adoption there is a need to focus on the feasibility of constructing these measures using data typically available to decision makers in low resource settings.

The IDEAS authors, Josephine Exley et al, estimated effective coverage of childbirth care in Gombe State, northeast Nigeria, using two different combinations of facility data sources and examined their strengths and limitations for decision makers. Effective coverage captures information on four steps: access, facility inputs, receipt of interventions and process quality. For this paer, the authors linked data from the 2018 Nigerian Demographic and Health Survey (NDHS) to two sources of health facility data: (1) comprehensive health facility survey data generated by the IDEAS project; and (2) District Health Information Software 2 (DHIS2). For each combination of data sources, we examined which steps were feasible to calculate, the size of the drop in coverage between steps and the resulting estimate of effective coverage. The analysis included 822 women with a recent live birth, 30% of whom attended a facility for childbirth.

Results from the paper indicated that effective coverage was low: 2% based on the project data and less than 1% using the DHIS2. Linking project data with NDHS, it was feasible to measure all four steps; using DHIS2 it was possible to estimate three steps: no data was available to measure process quality.

The authors of the paper conclude that the provision of high quality care is suboptimal in this high mortality setting where access and facility readiness to provide care, crucial foundations to the provision of high quality of care, have not yet been met. This study demonstrates that partial effective coverage measures can be constructed from routine data combined with nationally representative surveys. Advocacy to include process of care indicators in facility summary reports could optimise this data source for decision making.


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Josephine Exley

Research Fellow

Professor Claudia Hanson

Professor of implementation science and perinatal epidemiology

Dr Abdulrahman Shuaibu

Executive Secretary Gombe State Primary Health Care Development Agency

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Dr Nasir Umar

IDEAS Nigeria Country Coordinator and Assistant Professor

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Professor Tanya Marchant

IDEAS Principal Investigator and Professor