Sub-Saharan Africa’s Progress Towards MDGs 4 & 5: Do Changes in Coverage of Maternal and Child Health Interventions Enlarge or Lessen the Equity Gap?

Session: Equitable Coverage: Supporting Those Most Vulnerable

Presenter: Jean Christophe Fotso, Concern Worldwide
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Background: The Millennium Development Goals (MDGs) did not include any equity focus, yet for many regions of the developing world and sub-Saharan Africa in particular, inequities constitute major barriers to development. This paper examines trends in the coverage of key maternal, newborn and child health (MNCH) interventions, compares trends in coverage of interventions with changes in poor-rich gaps over time, and draws implications and lessons for applying an equity lens to programming.

Methods: All sub-Saharan African (SSA) countries with four Demographic and Health Survey (DHS) data points since the 1990s were included in the analysis. Three indicators are analyzed: modern contraceptive prevalence rate (MCPR), skilled birth attendance (SBA), and full vaccination. The rich-poor ratio, derived from the household wealth index recoded as tertiles, serves as the equity variable. We use population figures to generate weighted averages of aggregate indicators for West & Central Africa, Eastern & Southern Africa, and the region as a whole.

Results: SSA’s MCPR expanded steadily from 10% in the early 1990s to 24% in the 2010s. Encouragingly, the poor-rich gap shrank from nearly 5.1 to 2.3. SBA remained virtually stagnant at 45% until the mid-2000s, and jumped to 53% at the end the study period. The equity gap remained constant throughout the period at 3.1. The rapid increase in childhood vaccination coverage in the last 6-8 years offset the decline recorded in the 1990s. The gap between the rich and the poor remained low at around 1.6.

Conclusion: Improvements in MCPR have been achieved by narrowing the gap between the lowest and highest tertiles. Focused efforts are needed to address the persistent inequity in SBA and immunization by targeting the poor subgroups of the population. In the absence of targeting, progress towards the achievement of the targets of the health MDGs may be limited.