The DHS Program

Measurement Approaches for Effective Coverage Estimation (English) 

Document Type

Methodological Reports

Publication Topic(s)

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

Country(s)

Malawi, Senegal, Tanzania, Nepal, Haiti

Language

English

Recommended Citation

Riese, Sara, Shireen Assaf, and Thomas Pullum. 2021. Measurement Approaches for Effective Coverage Estimation. DHS Methodological Reports No. 31. Rockville, Maryland, USA: ICF.

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Publication Date

August 2021

Publication ID

MR31

Abstract:

Effective coverage is increasingly being used to evaluate maternal and child health programs. Effective coverage can be described as crude coverage adjusted for the quality of care provided. However, there are many ways to calculate effective coverage – including using different datasets or different measures of quality – that may result in different conclusions about a program. This report compares three different approaches to calculating effective coverage in antenatal care and sick child care in five countries – Haiti, Malawi, Nepal, Senegal, and Tanzania. The first approach uses data from Demographic and Health Surveys (DHS) to estimate effective coverage. The second approach combines DHS data with basic measures of health facility readiness and process quality from Service Provision Assessment (SPA) data. The third approach combines DHS data with expanded measures of health facility readiness and process quality from SPA data. Results show that estimates of effective antenatal care coverage were higher when only DHS data were used in the calculations. The sick child care effective coverage estimates were lower when only DHS data were used. Incorporating SPA data allowed for estimation of more steps along the effective coverage cascade. Comparisons of the basic measures of readiness and process quality used in Approach 2 and the expanded measures used in Approach 3 showed that the effect of these measures depended on the service area and country. With antenatal care, in three countries, the expanded measures resulted in lower quality-adjusted coverage, while in Malawi and Tanzania, the quality-adjusted coverage was higher. With sick child care, the expanded measures resulted in lower quality-adjusted measures in all countries, although the differences were very small in Nepal and Senegal. This study explored different approaches to calculating effective coverage and provides insights into how to contextualize the measures with different approaches. When using only DHS data, the effective coverage estimates are likely to be an overestimate of antenatal care or sick child care effective coverage. Using data from health facility assessments such as the SPA can provide better estimates of effective coverage, while using a basic or expanded measure of readiness and process quality of care results in similar estimates of quality-adjusted coverage.