Abstract
ObjectiveTo examine inequalities and opportunity gaps in co-coverage of health and nutrition interventions in seven countries.MethodsWe used data from the most recent (2015–2018) demographic and health surveys of mothers with children younger than 5 years in Afghanistan (n = 19 632), Bangladesh (n = 5051), India (n = 184 641), Maldives (n = 2368), Nepal (n = 3998), Pakistan (n = 8285) and Sri Lanka (n = 7138). We estimated co-coverage for a set of eight health and eight nutrition interventions and assessed within-country inequalities in co-coverage by wealth and geography. We examined opportunity gaps by comparing coverage of nutrition interventions with coverage of their corresponding health delivery platforms.FindingsOnly 15% of 231 113 mother–child pairs received all eight health interventions (weighted percentage). The percentage of mother–child pairs who received no nutrition interventions was highest in Pakistan (25%). Wealth gaps (richest versus poorest) for co-coverage of health interventions were largest for Pakistan (slope index of inequality: 62 percentage points) and Afghanistan (38 percentage points). Wealth gaps for co-coverage of nutrition interventions were highest in India (32 percentage points) and Bangladesh (20 percentage points). Coverage of nutrition interventions was lower than for associated health interventions, with opportunity gaps ranging from 4 to 54 percentage points.ConclusionCo-coverage of health and nutrition interventions is far from optimal and disproportionately affects poor households in south Asia. Policy and programming efforts should pay attention to closing coverage, equity and opportunity gaps, and improving nutrition delivery through health-care and other delivery platforms.
Highlights
Universal health coverage (UHC) is fundamental to achieving the sustainable development goals (SDGs), reducing inequalities and ensuring that no one is left behind.[1]
Our data included a total sample of 231 113 mother–child pairs: 19 632 in Afghanistan, 5051 in Bangladesh, 184 641 in India, 2368 in Maldives, 3998 in Nepal, 8285 in Pakistan and 7138 in Sri Lanka (Table 1)
Coverage of nutrition interventions was much lower than coverage of health interventions (Table 2)
Summary
Universal health coverage (UHC) is fundamental to achieving the sustainable development goals (SDGs), reducing inequalities and ensuring that no one is left behind.[1] Timely delivery of a complete package of health and nutrition interventions to women during pregnancy and to children during early childhood is a goal of global and national health and nutrition initiatives. An index of co-coverage of health interventions has been proposed to track coverage and assess progress towards UHC.[2,3,4] This widely used co-coverage index is a cumulative count of eight preventive health interventions that should be received by mothers and children.[4,5] this index includes only one nutrition intervention and is an inadequate measure of nutrition intervention co-coverage. Nutrition interventions are key components of UHC.[6] There is evidence that a package of nutrition interventions, if scaled to 90% coverage, could reduce stunting by 20% and reduce infant and child mortality by 15%.7. Coverage data for nutrition interventions along the continuum of care remain scarce
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