Addressing inequity to achieve the maternal and child health millennium development goals: looking b
Authors: George M Ruhago, Frida N Ngalesoni and Ole F Norheim
Inequity in access to and use of child and maternal health interventions is impeding progress
towards the maternal and child health Millennium Development Goals. This study explores
the potential health gains and equity impact if a set of priority interventions for mothers and
under fives were scaled up to reach national universal coverage targets for MDGs in
We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child
mortality and the number of lives saved across wealth quintiles and between rural and urban
settings. High impact maternal and child health interventions were modelled for a five-year
scale up, by linking intervention coverage, effectiveness and cause of mortality using data
from Tanzania. Concentration curves were drawn and the concentration index estimated to
measure the equity impact of the scale up.
In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers
and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage
to equal levels across quintiles would reduce inequality in maternal and child mortality from
a pro rich concentration index of −0.11 (maternal) and −0.12 (children) to a more equitable
concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an
eight times greater reduction in maternal deaths than in urban areas and a five times greater
reduction in child deaths than in urban areas.
Scaling up priority maternal and child health interventions to equal levels would potentially
save far more lives in the poorest populations, and would accelerate equitable progress
towards maternal and child health MDGs.
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