Effective Coverage for Nutrition: Operationalizing Effective Coverage Cascades for Nutrition Interventions Delivered to Pregnant Women and Children

Abstract

Abstract Objectives Many low and middle income country (LMIC) decision makers rely on data from multi-topic household surveys to identify the proportion of the population that has been reached with nutrition services, but these surveys do not always account for the quality of the services. Effective coverage cascades, commonly used in health systems research, capture measures of both coverage and quality to generate actionable information to improve nutrition programs, interventions, and policies. This study aims to describe the operationalization of effective coverage cascades for maternal and child nutrition interventions delivered through the health system using extant data in LMICs. Methods By linking household survey and health facility assessment data from seven LMICs, effective coverage cascades were developed for nutrition interventions delivered through antenatal care visits and sick-child visits. Facility readiness and provision of care index scores were defined for each intervention from clinical guidelines and an expert survey, then refined based on data availability. The facility readiness and provision of care scores were linked to individual care-seeking episodes from household survey data based on geographic domain and facility type. Finally, steps of the coverage cascade for each service in each country were estimated. Results National estimates of the effective coverage cascade for each set of nutrition interventions will be presented. Analysis is ongoing, however preliminary findings show gaps in service readiness such as lack of provider training and gaps in provision of care such as limited nutrition counseling. A substantial drop is seen from service contact to input-adjusted coverage to quality-adjusted coverage for both antenatal care and sick child care. Conclusions The cascade approach yielded summary measures that were useful for identifying high-level barriers to effective coverage; however, detailed measures within the cascade may be more useful for evidence-based decision making. Data availability on quality of care for nutrition interventions is scant, highlighting an opportunity to expand facility-based surveys to include nutrition interventions delivered through the health system. Funding Sources Bill & Melinda Gates Foundation through the DataDENT initiative and the Improving Measurement and Program Design grant.