Abstract
ObjectiveTo generate and evaluate an indicator of the health system’s performance in the area of maternal and reproductive health in Colombia.Materials and methodsAn indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator’s score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable.ResultsThe factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator’s behavior was found to have an association with the unsatisfied basic needs index and women’s education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable.DiscussionThe performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.
Highlights
At the beginning of this century, Colombia was among 189 countries to adopt the Millennium Development Declaration, which included a commitment to fulfill eight objectives
The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia
The present study demonstrates the existence of a gap in the health system’s performance in the areas of coverage and utilization of maternal and reproductive health services in Colombia
Summary
At the beginning of this century, Colombia was among 189 countries to adopt the Millennium Development Declaration, which included a commitment to fulfill eight objectives One of those objectives is to improve maternal health (Millennium Development Objective (MDO) # 5) [1, 2]. Maternal mortality was chosen as the primary health outcome to evaluate progress towards achieving this objective, with the goal of a reduction of 75% in the maternal mortality ratio (MMR) from 1990 to 2015. To this end, renewing the enrollment of vulnerable populations in health services was proposed as well as substantially improving access to health care [1]. These disparities continued through 2013, when the ratio was 12.1 per 100,000 live births and 232.8 per 100,000 live births, respectively [7, 8]
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