1354Delivery channels and socioeconomic inequalities in coverage of RMNCH interventions: analysis across 36 LMICs

Abstract

Abstract Background Socioeconomic inequalities in the coverage of reproductive, maternal, neonatal, and child health (RMNCH) interventions have been frequently described in global reports, but little is known about how inequalities vary across indicators in low- and middle-income countries (LMICs). Methods In this cross-sectional study, we identified publicly available national surveys from LMICs. We identified the most recent survey from the period 2010–19 for 36 countries containing data for our preselected set of 18 RMNCH interventions. Twenty-one countries also had information on two common malaria interventions. We classified interventions into four groups according to their predominant delivery channels: health facility-based, community-based, environmental, and culturally driven. We estimated absolute inequalities using the slope index of inequality (SII) and relative inequalities using the concentration index (CIX). Results We observed higher coverage levels among wealthier households than poorer households for most interventions in most countries, except for two breastfeeding indicators showing higher coverage for poor households than wealthy households. Environmental interventions were the most unequal, particularly use of clean fuels. Primarily health facility-based interventions—e.g. institutional childbirth—also usually had pro-rich patterns. By comparison, primarily community-based interventions, including those against malaria, were more equitably distributed. Conclusions Community-based interventions are usually more equitably distributed than health facility-based or environmental interventions. Policymakers need to learn from community delivery channels to promote more equitable access to all RMNCH interventions. Key messages The delivery channels framework is useful for designing equitable health policies and programmes, which must adapt the successes of community-based interventions to all RMNCH interventions.