Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010
Identifieur interne : 001838 ( Main/Exploration ); précédent : 001837; suivant : 001839Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010
Auteurs : Katherine Ellicott Colson [États-Unis] ; Laura Dwyer-Lindgren [États-Unis] ; Tom Achoki [États-Unis, Botswana] ; Nancy Fullman [États-Unis] ; Matthew Schneider [États-Unis] ; Peter Mulenga [Zambie] ; Peter Hangoma [Norvège, Zambie] ; Marie Ng [États-Unis] ; Felix Masiye [États-Unis, Zambie] ; Emmanuela Gakidou [États-Unis]Source :
- BMC Medicine [ 1741-7015 ] ; 2015.
Abstract
Achieving universal health coverage and reducing health inequalities are primary goals for an increasing number of health systems worldwide. Timely and accurate measurements of levels and trends in key health indicators at local levels are crucial to assess progress and identify drivers of success and areas that may be lagging behind.
We generated estimates of 17 key maternal and child health indicators for Zambia’s 72 districts from 1990 to 2010 using surveys, censuses, and administrative data. We used a three-step statistical model involving spatial-temporal smoothing and Gaussian process regression. We generated estimates at the national level for each indicator by calculating the population-weighted mean of the district values and calculated composite coverage as the average of 10 priority interventions.
National estimates masked substantial variation across districts in the levels and trends of all indicators. Overall, composite coverage increased from 46% in 1990 to 73% in 2010, and most of this gain was attributable to the scale-up of malaria control interventions, pentavalent immunization, and exclusive breastfeeding. The scale-up of these interventions was relatively equitable across districts. In contrast, progress in routine services, including polio immunization, antenatal care, and skilled birth attendance, stagnated or declined and exhibited large disparities across districts. The absolute difference in composite coverage between the highest-performing and lowest-performing districts declined from 37 to 26 percentage points between 1990 and 2010, although considerable variation in composite coverage across districts persisted.
Zambia has made marked progress in delivering maternal and child health interventions between 1990 and 2010; nevertheless, substantial variations across districts and interventions remained. Subnational benchmarking is important to identify these disparities, allowing policymakers to prioritize areas of greatest need. Analyses such as this one should be conducted regularly and feed directly into policy decisions in order to increase accountability at the local, regional, and national levels.
The online version of this article (doi:10.1186/s12916-015-0308-5) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12916-015-0308-5
PubMed: 25889124
PubMed Central: 4382853
Affiliations:
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USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Economics, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Department of Economics, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Gakidou, Emmanuela" sort="Gakidou, Emmanuela" uniqKey="Gakidou E" first="Emmanuela" last="Gakidou">Emmanuela Gakidou</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, 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Laura" uniqKey="Dwyer Lindgren L" first="Laura" last="Dwyer-Lindgren">Laura Dwyer-Lindgren</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Achoki, Tom" sort="Achoki, Tom" uniqKey="Achoki T" first="Tom" last="Achoki">Tom Achoki</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff3">Ministry of Health of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Ministry of Health of Botswana, Gaborone</wicri:regionArea><wicri:noRegion>Gaborone</wicri:noRegion></affiliation></author><author><name sortKey="Fullman, Nancy" sort="Fullman, Nancy" uniqKey="Fullman N" first="Nancy" last="Fullman">Nancy Fullman</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Schneider, Matthew" sort="Schneider, Matthew" uniqKey="Schneider M" first="Matthew" last="Schneider">Matthew Schneider</name><affiliation wicri:level="2"><nlm:aff id="Aff4">USAID, Washington, DC USA</nlm:aff><country>États-Unis</country><placeName><region type="state">District de Columbia</region></placeName><wicri:cityArea>USAID, Washington</wicri:cityArea></affiliation></author><author><name sortKey="Mulenga, Peter" sort="Mulenga, Peter" uniqKey="Mulenga P" first="Peter" last="Mulenga">Peter Mulenga</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Clinton Health Access Initiative, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Clinton Health Access Initiative, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Hangoma, Peter" sort="Hangoma, Peter" uniqKey="Hangoma P" first="Peter" last="Hangoma">Peter Hangoma</name><affiliation wicri:level="1"><nlm:aff id="Aff6">Department of Economics, University of Bergen, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Department of Economics, University of Bergen, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Economics, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Department of Economics, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Marie" sort="Ng, Marie" uniqKey="Ng M" first="Marie" last="Ng">Marie Ng</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Masiye, Felix" sort="Masiye, Felix" uniqKey="Masiye F" first="Felix" last="Masiye">Felix Masiye</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Economics, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Department of Economics, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Gakidou, Emmanuela" sort="Gakidou, Emmanuela" uniqKey="Gakidou E" first="Emmanuela" last="Gakidou">Emmanuela Gakidou</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Institute for Health Metrics and Evaluation, University of Washington, Seattle</wicri:cityArea></affiliation></author></analytic><series><title level="j">BMC Medicine</title><idno type="eISSN">1741-7015</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Achieving universal health coverage and reducing health inequalities are primary goals for an increasing number of health systems worldwide. Timely and accurate measurements of levels and trends in key health indicators at local levels are crucial to assess progress and identify drivers of success and areas that may be lagging behind.</p></sec><sec><title>Methods</title><p>We generated estimates of 17 key maternal and child health indicators for Zambia’s 72 districts from 1990 to 2010 using surveys, censuses, and administrative data. We used a three-step statistical model involving spatial-temporal smoothing and Gaussian process regression. We generated estimates at the national level for each indicator by calculating the population-weighted mean of the district values and calculated composite coverage as the average of 10 priority interventions.</p></sec><sec><title>Results</title><p>National estimates masked substantial variation across districts in the levels and trends of all indicators. Overall, composite coverage increased from 46% in 1990 to 73% in 2010, and most of this gain was attributable to the scale-up of malaria control interventions, pentavalent immunization, and exclusive breastfeeding. The scale-up of these interventions was relatively equitable across districts. In contrast, progress in routine services, including polio immunization, antenatal care, and skilled birth attendance, stagnated or declined and exhibited large disparities across districts. The absolute difference in composite coverage between the highest-performing and lowest-performing districts declined from 37 to 26 percentage points between 1990 and 2010, although considerable variation in composite coverage across districts persisted.</p></sec><sec><title>Conclusions</title><p>Zambia has made marked progress in delivering maternal and child health interventions between 1990 and 2010; nevertheless, substantial variations across districts and interventions remained. Subnational benchmarking is important to identify these disparities, allowing policymakers to prioritize areas of greatest need. Analyses such as this one should be conducted regularly and feed directly into policy decisions in order to increase accountability at the local, regional, and national levels.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12916-015-0308-5) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="O Onnell, T" uniqKey="O Onnell T">T O’Connell</name></author><author><name sortKey="Rasanathan, K" uniqKey="Rasanathan K">K Rasanathan</name></author><author><name sortKey="Chopra, M" uniqKey="Chopra M">M Chopra</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Victora, Cg" uniqKey="Victora C">CG Victora</name></author><author><name sortKey="Wagstaff, A" uniqKey="Wagstaff A">A Wagstaff</name></author><author><name sortKey="Schellenberg, Ja" 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Foreman</name></author><author><name sortKey="Naghavi, M" uniqKey="Naghavi M">M Naghavi</name></author><author><name sortKey="Ahn, Sy" uniqKey="Ahn S">SY Ahn</name></author><author><name sortKey="Wang, M" uniqKey="Wang M">M Wang</name></author><author><name sortKey="Makela, Sm" uniqKey="Makela S">SM Makela</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rajaratnam, Jk" uniqKey="Rajaratnam J">JK Rajaratnam</name></author><author><name sortKey="Marcus, Jr" uniqKey="Marcus J">JR Marcus</name></author><author><name sortKey="Flaxman, Ad" uniqKey="Flaxman A">AD Flaxman</name></author><author><name sortKey="Wang, H" uniqKey="Wang H">H Wang</name></author><author><name sortKey="Levin Rector, A" uniqKey="Levin Rector A">A Levin-Rector</name></author><author><name sortKey="Dwyer, L" uniqKey="Dwyer L">L Dwyer</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wang, H" uniqKey="Wang H">H 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Dwyer-Lindgren</name></author><author><name sortKey="Mokdad, Ah" uniqKey="Mokdad A">AH Mokdad</name></author><author><name sortKey="Srebotnjak, T" uniqKey="Srebotnjak T">T Srebotnjak</name></author><author><name sortKey="Flaxman, Ad" uniqKey="Flaxman A">AD Flaxman</name></author><author><name sortKey="Hansen, Gm" uniqKey="Hansen G">GM Hansen</name></author><author><name sortKey="Murray, Cj" uniqKey="Murray C">CJ Murray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brugha, R" uniqKey="Brugha R">R Brugha</name></author><author><name sortKey="Simbaya, J" uniqKey="Simbaya J">J Simbaya</name></author><author><name sortKey="Walsh, A" uniqKey="Walsh A">A Walsh</name></author><author><name sortKey="Dicker, P" uniqKey="Dicker P">P Dicker</name></author><author><name sortKey="Ndubani, P" uniqKey="Ndubani P">P Ndubani</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Sepulveda, J" uniqKey="Sepulveda 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J">J Waage</name></author><author><name sortKey="Banerji, R" uniqKey="Banerji R">R Banerji</name></author><author><name sortKey="Campbell, O" uniqKey="Campbell O">O Campbell</name></author><author><name sortKey="Chirwa, E" uniqKey="Chirwa E">E Chirwa</name></author><author><name sortKey="Collender, G" uniqKey="Collender G">G Collender</name></author><author><name sortKey="Dieltiens, V" uniqKey="Dieltiens V">V Dieltiens</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Stuckler, D" uniqKey="Stuckler D">D Stuckler</name></author><author><name sortKey="Basu, S" uniqKey="Basu S">S Basu</name></author><author><name sortKey="Mckee, M" uniqKey="Mckee M">M McKee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gwatkin, Dr" uniqKey="Gwatkin D">DR Gwatkin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Easterly, W" uniqKey="Easterly W">W Easterly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boerma, Jt" uniqKey="Boerma J">JT Boerma</name></author><author><name sortKey="Stansfield, Sk" uniqKey="Stansfield S">SK Stansfield</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murray, Cj" uniqKey="Murray C">CJ Murray</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Botswana</li><li>Norvège</li><li>Zambie</li><li>États-Unis</li></country><region><li>Californie</li><li>District de Columbia</li><li>Washington (État)</li></region></list><tree><country name="États-Unis"><region name="Californie"><name sortKey="Colson, Katherine Ellicott" sort="Colson, Katherine Ellicott" uniqKey="Colson K" first="Katherine Ellicott" last="Colson">Katherine Ellicott Colson</name></region><name sortKey="Achoki, Tom" sort="Achoki, Tom" uniqKey="Achoki T" first="Tom" last="Achoki">Tom Achoki</name><name sortKey="Dwyer Lindgren, Laura" sort="Dwyer Lindgren, Laura" uniqKey="Dwyer Lindgren L" first="Laura" last="Dwyer-Lindgren">Laura Dwyer-Lindgren</name><name sortKey="Fullman, Nancy" sort="Fullman, Nancy" uniqKey="Fullman N" first="Nancy" last="Fullman">Nancy Fullman</name><name sortKey="Gakidou, Emmanuela" sort="Gakidou, Emmanuela" uniqKey="Gakidou E" first="Emmanuela" last="Gakidou">Emmanuela Gakidou</name><name sortKey="Masiye, Felix" sort="Masiye, Felix" uniqKey="Masiye F" first="Felix" last="Masiye">Felix Masiye</name><name sortKey="Ng, Marie" sort="Ng, Marie" uniqKey="Ng M" first="Marie" last="Ng">Marie Ng</name><name sortKey="Schneider, Matthew" sort="Schneider, Matthew" uniqKey="Schneider M" first="Matthew" last="Schneider">Matthew Schneider</name></country><country name="Botswana"><noRegion><name sortKey="Achoki, Tom" sort="Achoki, Tom" uniqKey="Achoki T" first="Tom" last="Achoki">Tom Achoki</name></noRegion></country><country name="Zambie"><noRegion><name sortKey="Mulenga, Peter" sort="Mulenga, Peter" uniqKey="Mulenga P" first="Peter" last="Mulenga">Peter Mulenga</name></noRegion><name sortKey="Hangoma, Peter" sort="Hangoma, Peter" uniqKey="Hangoma P" first="Peter" last="Hangoma">Peter Hangoma</name><name sortKey="Masiye, Felix" sort="Masiye, Felix" uniqKey="Masiye F" first="Felix" last="Masiye">Felix Masiye</name></country><country name="Norvège"><noRegion><name sortKey="Hangoma, Peter" sort="Hangoma, Peter" uniqKey="Hangoma P" first="Peter" last="Hangoma">Peter Hangoma</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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