To use effective coverage measures in practice we need greater harmonisation and transparency
published 19 January 2022
published 19 January 2022
A systematic review, published in the Journal of Global Health, aimed to examine how effective coverage measures of life-saving interventions from childbirth to children up to the age of nine years have been defined in the literature and how well these effective coverage measures fit the proposed health-service coverage cascade.
Traditionally, measures of maternal, newborn and child health interventions have focused on contact or intervention coverage—defined as the proportion of a population in need of a service or intervention that received the service. Contact coverage however tends to overestimate the positive health impacts and doesn’t account for the content or quality of care delivered. Effective coverage moves beyond contact coverage by introducing the dimension of quality of care.
In 2020 a group of experts laid out recommendations for standardising effective coverage measurement in maternal, newborn, child and adolescent health and nutrition. They recommended that effective coverage be explained using health-service coverage cascades applied at the population level. The group identified challenges to operationalising the cascade, including defining content and data sources. In response, a systematic review was carried out searching seven scientific journal databases and the reference lists of earlier reviews. The review identified 64 effective coverage measures across 33 relevant studies for closer examination.
The most frequently examined interventions were around childbirth and the immediate newborn period. No studies examined measured among children aged five to nine years. The review identified a lack of harmonisation in how effective coverage measures have been defined and constructed.
Conclusions and recommendations
The study authors conclude that there is a need for greater harmonisation of effective coverage definitions to allow for comparisons across settings and over time. The findings also highlight that a shift in measurement approach will be required if the coverage cascade is to be adopted.
In the short term this review suggests the need for greater specificity and transparency in the reporting of effective coverage measures. In the longer term it requires global guidance on best practices. The mapping of existing effective coverage measures against the cascade presented in this review provides a useful starting point.