Effective Intervention Coverage

Research Team

Effective coverage is critical to evaluating health initiatives, interventions, and system-wide reform because it tracks changes in outputs, which can be measured over short periods, with the ultimate goal of affecting health outcomes, which may take years to observe. Effective coverage of interventions provides a comprehensive health service metric that includes the notion of quality alongside utilization and need. It is defined as the fraction of the potential health gain of an intervention that is being delivered to a population and is used to track the performance of societies in addressing health challenges. Policymakers need tools like effective coverage to track how they are doing today to improve population health in the future.

The Effective Intervention Coverage research team’s work plays an essential role in IHME’s ground-breaking Global Burden of Diseases, Injuries, and Risk Factors Study 2010 and our work in health information systems. The analytical tools we use and refine to measure effective coverage of our key interventions can be applied to new research and projects throughout IHME.

Key Activities

Research effective coverage of diabetes treatment

IHME researchers examined the effectiveness of the health system response to the challenge of diabetes across different settings and explored the inequalities in diabetes care that are attributable to socioeconomic factors. A substantial proportion of individuals with diabetes remains undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of women in Scotland and the US to 62% of men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, blood pressure, and cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the US.

Our findings indicate that there are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of high blood pressure and high cholesterol. Although no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.

Analyze skilled birth attendance and antenatal care

The delivery of high quality antenatal and intrapartum care are considered key components of efforts to achieve the Millennium Development Goals (MDGs) for child (MDG 4) and maternal health (MDG 5). We analyzed unit record data from more than 250 surveys to determine the coverage of one antenatal care (ANC) visit from a skilled provider, four ANC visits from a skilled provider, skilled birth attendance (SBA), and in-facility birth, and added to this reported estimates from surveys. We used statistical models to estimate trends in coverage for 137 countries in developing regions defined by the Global Burden of Disease Study 2005 for the period 1985 to 2010.

We found that SBA coverage increased substantially from about 50% in the mid-1980s in both Andean Latin America and North Africa/Middle East to about 85% in 2010. In stark contrast, South Asia only began to see improvement from the early 1990s and at a slower rate, while SBA coverage in East sub-Saharan Africa has remained constant since the 1980s. Despite the MDGs, global progress has been relatively gradual, and our research shows that many countries will fail to reach universal coverage of antenatal and intrapartum care by 2015. Accelerated progress, however, on scaling up antenatal and intrapartum care has been demonstrated in several countries.

Impact

The Effective Intervention Coverage research team informs policymakers and public health researchers on population-level coverage of priority interventions. Leaders in any health system should focus on tracking effective coverage to determine how much public health contributes to better health outcomes for individuals and populations. Actions taken today, such as reducing tobacco consumption or increasing immunization coverage, will demonstrate positive health effects decades from now.

Mexico was the first country to fully implement the effective coverage framework to monitor and evaluate the performance of its health system. In this case, the effective coverage framework provided insights into Mexico’s epidemiological transition and highlighted the need to shift Mexico’s policy priorities, which had been focused predominantly on communicable diseases and maternal and child health, to its surging burden of disease due to chronic diseases, such as diabetes and high blood pressure.

Related Publications & Presentations

Research Articles

Lim SS, Fullman N, Stokes A, Ravishankar N, Masiye F, Murray CJL, Gakidou E. Net benefits: a multicountry analysis of observational data examining associations between insecticide-treated mosquito nets and health outcomes. PLoS Medicine. September 2011; 8(9): e1001.

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Gakidou E, Mallinger L, Abbott-Klafter J, Guerrero R, Villalpando S, Ridaura RL, Aekplakorn W, Naghavi M, Lim S, Lozano R, Murray CJL. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization. 2011; 89:172-183.

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Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ, Farzadfar F, Stevens GA, Lim SS, Riley LM, Ezzati M, on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Pressure). National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. The Lancet. 2011; doi:10.1016/S0140-6736(10)62036-3.

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Roth GA, Fihn SD, Mokdad AH, Aekplakorn W, Hasegawa T, Lim SS. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. The Bulletin of the World Health Organization. 2011;89:92–101.

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Flaxman AD, Fullman N, Otten MW Jr., Menon M, Cibulskis RE, Ng M, Murray CJL, Lim SS. Rapid scaling-up of insecticide-treated bed net coverage in Africa and its relationship with development assistance for health: A systematic synthesis of supply, distribution, and household survey data. PLoS Medicine. 2010 August 17; 7(8): e1000328.

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Lim S, Stein D, Charrow A, Murray CJL. Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. The Lancet. 2008 Dec 13; 372:2031–2046.

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Lim SS, Gaziano TA, Gakidou E, Reddy KS, Farzadfar F, Lozano R, Rodgers A. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs. The Lancet. 2007 Dec 15; 370:2054–2062.

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