Meeting the Global Target in Reproductive, Maternal, Newborn, and Child Health Care Services in Low- and Middle-Income Countries.

Md Mehedi Hasan,Md Shahadut Hossain,Saifuddin Ahmed,Ricardo J Soares Magalhaes,Md Saimul Islam,Tuhin Biswas,Sayem Ahmed,Abdullah A Mamun,Yaqoot Fatima

doi:10.9745/ghsp-d-20-00097

Abstract

Improving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Many low- and middle-income countries (LMICs) are striving to achieve RMNCH-related Sustainable Development Goals (SDGs). We monitored progress, made projections, and calculated the average annual rate of change needed to achieve universal (100%) access of RMNCH service indicators by 2030. We extracted Demographic and Health Survey (DHS) data of 75 LMICs to estimate the coverage of RMNCH indicators and composite coverage index (CCI) to measure health system strengths. Bayesian linear regression models were fitted to predict the coverage of indicators and the probability of achieving targets. The projection analysis included 64 countries with available information for at least 2 DHS rounds. No countries are projected to reach universal CCI by 2030; only Brazil, Cambodia, Colombia, Honduras, Morocco, and Sierra Leone will have more than 90% CCI. None of the LMICs will achieve universal coverage of all RMNCH indicators by 2030, although some may achieve universal coverage for specific services. To meet targets for universal service access by 2030, most LMICs must attain a 2-fold increase in the coverage of indicators from 2019 to 2030. Coverage of RMNCH indicators, the probability of target attainments, and the required rate of increase vary significantly across the spectrum of sociodemographic disadvantages. Most countries with poor historical and current trends for RMNCH coverage are likely to experience a similar scenario in 2030. Countries with lower coverage had higher disparities across the subgroups of wealth, place of residence, and women's/mother's education and age; these disparities are projected to persist in 2030. None of the LMICs will meet the SDG RMNCH 2030 targets without scaling up essential RMNCH interventions, reducing gaps in coverage, and reaching marginalized and disadvantaged populations.

Highlights

Improving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality
Despite significant improvements in health Millennium Development Goals (MDGs) globally, the population-level inequality between the poorest and richest households and between urban and rural areas did not change in many low- and middle-income countries (LMICs).[1]
We demonstrated that none of the LMICs would be www.ghspjournal.org

Summary

Introduction

Maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Reducing maternal and child morbidity and mortality and improving reproductive, maternal, newborn, and child health (RMNCH) are top priorities of the global health agenda, for low- and middle-income countries (LMICs).[1] During the era of the Millennium Development Goals (MDGs) between 1990 and 2015, coverage of effective RMNCH interventions to reduce maternal and child morbidity and mortality was scaled up in LMICs.[2] This global initiative showed rapid progress in increasing the coverage of RMNCH care services such as accelerated coverage of demand for family planning satisfied with modern contraceptive methods (mDFPS), presence of a skilled birth attendant (SBA), and radically increased coverage of child vaccinations, while other services had modest progress and a few were far behind in meeting the global targets.[3] Despite significant improvements in health MDGs globally, the population-level inequality between the poorest and richest households and between urban and rural areas did not change in many LMICs.[1] Most importantly, individual-level disparities in terms of gender, age, education, and geographical location suggested further review of global agendas for designing and implementing RMNCH interventions was needed.[1]. The top priority of SDG target 3.8 is to achieve universal health coverage (UHC), which means that[5]: all individuals and communities receive the health services they need without suffering financial hardship

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