Peer-reviewed article
Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa
Cheikh Fayé, Fernando C. Wehrmeister, Dessalegn Y. Melesse, Martin Kavao Mutua, Abdoulaye Maïga et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined subnational inequalities in coverage of reproductive, maternal, newborn and child health interventions across 39 sub-Saharan African countries using data from household surveys. Large gaps exist between regions within countries, with different patterns: some have low coverage concentrated in capital cities, others have high national coverage with poor coverage in disadvantaged regions, and some have consistently high coverage everywhere. Although about half of countries showed improvement in reducing these gaps between 2004 and 2015, most countries still show persistent large inequalities. Poor governance and conflict were identified as potential barriers to reaching all children and mothers with essential health services.
Key points
- 39 sub-Saharan African countries studied using a composite coverage index for reproductive, maternal, newborn and child health interventions
- Large subnational inequalities exist within countries, with different patterns: some dominated by capital city advantage, others by disadvantaged regions, some with consistent high coverage
- Comparison of surveys around 2004 and 2015 found nearly half of 34 countries reduced subnational inequalities, but large gaps persisted in most countries
- Poor governance and conflict settings identified as contributing factors to persistent inequalities
- Major efforts to reduce within-country inequalities required to reach all women and children with essential interventions
Limitations
The document focuses on subnational inequality patterns but does not provide detailed data on specific interventions or age groups. The paper does not explain the mechanisms through which governance and conflict lead to inequality, limiting understanding of what actions might reduce gaps.
Abstract
Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women's, Children's and Adolescent's Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions.