The DHS Program

Inequalities in Effective Coverage by Urban Poverty Status (English) 

Document Type

Analytical Studies

Publication Topic(s)

Child Health and Development, Health facilities/SPA surveys, Maternal Health

Country(s)

Congo Democratic Republic, Ethiopia, Tanzania, Afghanistan, Nepal, Haiti

Language

English

Recommended Citation

Riese, Sara and Shireen Assaf. 2024. Inequalities in Effective Coverage by Urban Poverty Status. DHS Analytical Studies No. 89. Rockville, Maryland, USA: ICF

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Publication Date

May 2024

Publication ID

AS89

Abstract:

Previous research has established intra-urban disparities in intervention coverage and quality of care between the urban poor and non-poor. However, effective coverage (that is, combining measures of need for a health service with coverage and quality into one metric), is increasingly being used to evaluate the performance of urban health care systems. This study examined inequities in antenatal care (ANC) and sick child care effective coverage by urban poverty status in six countries: Afghanistan, Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Nepal, and Tanzania. Inequalities were assessed using previously developed measures that combine data from Demographic and Health Surveys (DHS) and Service Provision Assessment surveys. Results showed that more than half of urban women of reproductive age in Afghanistan and Ethiopia, and more than half of urban children under 5 in Afghanistan and DRC, were living in urban poor clusters. In contrast, fewer than 6% of urban women of reproductive age and fewer than 12% of urban children under 5 in Haiti, Nepal, and Tanzania lived in urban poor clusters. When we calculated effective coverage, results differed between the ANC and sick child care cascades. For ANC, statistically significant disparities in quality-adjusted coverage (the last of four steps in the cascade) were found in DRC, Ethiopia, and Haiti. The differences in urban poor versus non-poor effective coverage were driven by statistically significant differences in two DHS component measures: service contact and receipt of complete intervention. No statistically significant disparities were found in sick child effective coverage by urban poverty status in any of the countries. Policymakers and program managers should consider approaches to disaggregating effective coverage measures by urban poverty status whenever possible to identify urban populations most at risk.