New Methods to Assess Regional Differences in Continuum of Care from the Point of View of Women and Healthcare Providers

Presenter: Akira Shibanuma, The University of Tokyo

Background: Continuum of care has been advocated as an approach for improving maternal, neonatal, and child care. However, no widely accepted measurement has been developed for health administrators to evaluate its achievements at the national and sub-national levels. This study proposed two simple measurements of continuum of care and compared its achievements among different sub-national areas.

Methods: This study collected data from 1,500 women each using two community-level cross-sectional surveys in 2013 and 2014 in Ghana. The two measurements of continuum of care were “visit-based,” which captured if a woman sought services continuously for antenatal care four times or more, skilled delivery, and postnatal care three times (48 hours, and two and six weeks), and “component-based,” which captured if a health facility provided key components of services during visits. Differences among areas were presented as descriptive statistics and intra-class correlation coefficients based on multilevel logistic regression analysis.

Results: In the surveys in 2013 and 2014, only 8.0% and 8.1% of the women achieved visit-based continuum of care, while 12.2% and 12.7% of women achieved component-based continuum of care, respectively. The achievement rate of continuum of care varied across areas; it ranged from 0.0% to 35.0% based on visit-based measurement and from 0.0% to 65.0% based on component-based measurement in 2014. Intra-class correlation coefficients were 84% greater for component-based measurement than for visit-based measurement in 2014.

Conclusion: Continuum of care was poor, and it showed a wide gap among different sub-national areas in the study, according to repeated measurements. The gap was wide when it was measured according to the key components of services provided, which may reflect the differences in the levels of service across areas. The two measurements presented can be used as simple indicators to help improve maternal, neonatal, and child health services.