Effective coverage: a metric for monitoring Universal Health Coverage.

Marie Ng,Abraham D Flaxman,Joseph L Dieleman,Stephen S Lim,Christopher J L Murray,Nancy Fullman

doi:10.1371/journal.pmed.1001730

Marie Ng, Abraham D Flaxman + Show 4 more

Open Access

https://doi.org/10.1371/journal.pmed.1001730

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Abstract

A major challenge in monitoring universal health coverage (UHC) is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure health system performance at different levels. We view effective coverage as a relevant and actionable metric for tracking progress towards achieving UHC. In this paper, we review the concept of effective coverage and delineate the three components of the metric - need, use, and quality - using several examples. Further, we explain how the metric can be used for monitoring interventions at both local and global levels. We also discuss the ways that current health information systems can support generating estimates of effective coverage. We conclude by recognizing some of the challenges associated with producing estimates of effective coverage. Despite these challenges, effective coverage is a powerful metric that can provide a more nuanced understanding of whether, and how well, a health system is delivering services to its populations.

Highlights

Strengthening health systems, ensuring affordability of care, improving access to quality services, and building capacity are core tenets of universal health coverage (UHC)
The importance of systematically tracking the progress in attaining UHC was highlighted in the 2013 World Health Report [3], which drew attention to the dearth of empirical evidence for assessing and informing policies related to UHC
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Summary

Introduction

Strengthening health systems, ensuring affordability of care, improving access to quality services, and building capacity are core tenets of universal health coverage (UHC). When effective coverage was used to benchmark state-level health system performance in Mexico [10], the Ministry of Health selected a subset of interventions that most directly aligned with the country’s health priorities These selected interventions included a mixture of maternal and child health interventions (such as immunizations, antenatal care, and skilled birth attendance) and interventions for non-communicable diseases (such as cancer screening and hypertension treatment). National disease burden studies conducted in the United States, the United Kingdom, and China identify ischemic heart disease, chronic obstructive pulmonary disease (COPD), stroke, and lung cancer as the leading causes of premature mortality and disability for all three countries [15,16,17] This finding implies that some diseases could be treated as regional, and potentially global, health needs for monitoring effective coverage. - Focuses on the health care process - Involves indicators that target the resource and activity outputs of an intervention

Statistical methods

Limitations

Build capacity for measuring effective coverage

Conclusions

Findings

48. Monitoring Disparities in Chronic Conditions Study