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Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa

Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa
Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa
Background
With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes.

Methods
Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services.

Results
Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other.

Conclusion
While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.
1741-7015
1-10
Wigley, Adelle
21b38ae2-ffd3-4d45-bf29-843e6d62807f
Tejedor Garavito, Natalia
26fd242c-c882-4210-a74d-af2bb6753ee3
Alegana, Victor A.
17871690-1cac-4acd-9371-31c71cded2f4
Carioli, Alessandra
6c08c2a8-db01-49c5-811e-64a41d02845f
Ruktanonchai, Corrine W
44e6fcd0-246b-480e-8940-9557dbb7c0cc
Pezzulo, Carla
876a5393-ffbd-479a-9edf-f72a59ca2cb5
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b
Wigley, Adelle
21b38ae2-ffd3-4d45-bf29-843e6d62807f
Tejedor Garavito, Natalia
26fd242c-c882-4210-a74d-af2bb6753ee3
Alegana, Victor A.
17871690-1cac-4acd-9371-31c71cded2f4
Carioli, Alessandra
6c08c2a8-db01-49c5-811e-64a41d02845f
Ruktanonchai, Corrine W
44e6fcd0-246b-480e-8940-9557dbb7c0cc
Pezzulo, Carla
876a5393-ffbd-479a-9edf-f72a59ca2cb5
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b

Wigley, Adelle, Tejedor Garavito, Natalia, Alegana, Victor A., Carioli, Alessandra, Ruktanonchai, Corrine W, Pezzulo, Carla, Matthews, Zoe, Tatem, Andrew and Nilsen, Kristine (2020) Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa. BMC Medicine, 18 (237 (2020)), 1-10, [237 (2020)]. (doi:10.1186/s12916-020-01707-6).

Record type: Article

Abstract

Background
With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes.

Methods
Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services.

Results
Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other.

Conclusion
While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.

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More information

Accepted/In Press date: 13 July 2020
Published date: 8 September 2020

Identifiers

Local EPrints ID: 443875
URI: http://eprints.soton.ac.uk/id/eprint/443875
ISSN: 1741-7015
PURE UUID: 61beba2a-f0df-4277-af5d-e2215f78dc23
ORCID for Natalia Tejedor Garavito: ORCID iD orcid.org/0000-0002-1140-6263
ORCID for Carla Pezzulo: ORCID iD orcid.org/0000-0003-4775-1787
ORCID for Andrew Tatem: ORCID iD orcid.org/0000-0002-7270-941X

Catalogue record

Date deposited: 15 Sep 2020 16:34
Last modified: 18 Feb 2021 17:21

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