Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

• Published in: The Lancet (British edition) 2012-10, Vol.380 (9850), p.1331-1340
• Main Authors: Chopra, Mickey, MD, Sharkey, Alyssa, Dr, Dalmiya, Nita, MPH, Anthony, David, MSc, Binkin, Nancy, MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Child; Child Health Services; Child Mortality; Child Nutrition Disorders - prevention & control; Child Nutrition Disorders - therapy; children; Childrens health; Counseling; Delivery of Health Care - organization & administration; Developing Countries; Female; General aspects; health care workers; Health Services Accessibility; Healthcare Disparities; Humans; Internal Medicine; International Cooperation; issues and policy; Legislation; Low income groups; Mass media; Maternal & child health; Measles; Medical sciences; Metabolic diseases; Miscellaneous; Mortality; Nutrition; outreach; Outreach services; Pregnancy; Prenatal Care; Private sector; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Resource availability; Social marketing; supply balance
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(12)61423-8

Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels—ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions’ deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions—and, in some cases, health outcomes in children—including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.