Quality of Care and Effective Coverage Analysis for Sick Children in Low- and Middle-Income Countries

Abdoulaye Maïga, Johns Hopkins Bloomberg School of Public Health
Gouda Roland M. Mady, Johns Hopkins University Bloomberg School of Public Health
Elizabeth Hazel, Johns Hopkins Bloomberg School of Public Health
Safia Jiwani, John Hopkins University
Emily B. Wilson, Johns Hopkins University Bloomberg School of Public Health
Assanatou Bamogo, Johns Hopkins University Bloomberg School of Public Health
Helen Kiarie, Ministry of Health, Monitoring and Evaluation Division
Agbessi Amouzou, Johns Hopkins Bloomberg School of Public Health

We assessed curative child health service readiness and process quality and determined whether children are receiving health services with sufficient quality across countries. We linked data from household surveys and health facility surveys in eight countries to estimate the effective coverage of child illness treatment. We assessed gaps in service availability and coverage, lack of service readiness, missed opportunity and inadequate service process. We found large gaps in service readiness and significant inadequate service processes in all countries. The proportion of facilities visited ready for IMCI services ranged from 15% (Nepal) to 46.0% (Malawi). The proportion of children receiving care according to standards was 7% (Nepal) to 29% (Malawi). There were large inequity gaps in careseeking, quality of care and effective coverage by maternal level of education, poverty and place of residence. Our study highlighted suboptimal readiness of health facilities and poor process quality undermining accelerated progress in reducing child mortality in LMICs. Rapid progress toward the Sustainable Development Goals for health must address severe quality of care gaps in the treatment of most killer diseases among children by revamping the IMCI implementation strategy, strengthening health service access, capacity and quality of care to reach universal child health coverage.

Keywords: Health and Morbidity, Data and Methods, Linked data sets , Children, Adolescents, and Youth

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