District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018
| Autor: | Matthew H. Bonds, Michael Rich, Gaêtan Duval Solofomalala, Luc Rakotonirina, Mauricianot Randriamihaja, Karen E Finnegan, Ann C. Miller, Benedicte Razafinjato, Laliarisoa Raharimamonjy, Tara Loyd, Justin Haruna, Sidney Atwood, Marius Randriamanambintsoa, Germain Rakotozafy, Laura F Cordier, Hery-Tiana Rahaniraka Razanadrakato, Megan Murray, Andres Garchitorena |
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| Přispěvatelé: | Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Harvard Medical School [Boston] (HMS) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Rural Population
Inequality media_common.quotation_subject Impact evaluation 030231 tropical medicine Context (language use) maternal health lcsh:Infectious and parasitic diseases 03 medical and health sciences 0302 clinical medicine Pregnancy Universal Health Insurance Environmental health Per capita Madagascar cohort study Humans Maternal Health Services lcsh:RC109-216 030212 general & internal medicine Longitudinal Studies Child media_common Original Research 2. Zero hunger lcsh:R5-920 integumentary system Health Policy 1. No poverty Public Health Environmental and Occupational Health Health services research Infant Newborn health services research 3. Good health Child mortality Geography Child Preschool Community health child health Female [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie lcsh:Medicine (General) health systems Cohort study |
| Zdroj: | BMJ Global Health BMJ Global Health, BMJ Publishing Group Ltd, 2020, 5 (12), pp.e003647. ⟨10.1136/bmjgh-2020-003647⟩ BMJ Global Health, 2020, 5 (12), pp.e003647. ⟨10.1136/bmjgh-2020-003647⟩ BMJ Global Health, Vol 5, Iss 12 (2020) |
| ISSN: | 2059-7908 |
| Popis: | IntroductionDespite renewed commitment to universal health coverage and health system strengthening (HSS) to improve access to primary care, there is insufficient evidence to guide their design and implementation. To address this, we conducted an impact evaluation of an ongoing HSS initiative in rural Madagascar, combining data from a longitudinal cohort and primary health centres.MethodsWe carried out a district representative household survey at the start of the HSS intervention in 2014 in over 1500 households in Ifanadiana district, and conducted follow-up surveys at 2 and 4 years. At each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the HSS intervention and control catchments. We used logistic regression models to evaluate changes associated with exposure to the HSS intervention. We also estimated changes in health centre per capita utilisation during 2013 to 2018.ResultsChild mortality rates decreased faster in the HSS than in the control catchment. We observed significant improvements in care seeking for children under 5 years of age (OR 1.23; 95% CI 1.05 to 1.44) and individuals of all ages (OR 1.37, 95% CI 1.19 to 1.58), but no significant differences in maternal care coverage. Economic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators.ConclusionThe results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a HSS intervention in rural Madagascar. Additional improvements in this context of persistent geographical inequalities will require a stronger focus on community health. |
| Databáze: | OpenAIRE |
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