This study linked household and health facility surveys to estimate effective coverage of health facility delivery in Bangladesh, Haiti, Malawi, Nepal, Senegal, and Tanzania. We defined effective coverage as the crude coverage adjusted for the quality of care. Results show that the effective coverage ranges from 24% in Haiti to 66% in Malawi, representing substantial reductions (20% to 39%) from crude coverage rates. Malawi and Senegal were the only countries with an effective coverage higher than 50%. These findings suggest that many women delivered in a health facility but did not receive an adequate quality of care. For most countries, effective coverage differed significantly among regions, primarily due to regional variability in coverage. Effective coverage estimation accounts for an important component of universal health coverage—quality of care—and provides insight into why maternal and neonatal mortality rates in many countries are not declining as rapidly as expected.
Presented in Session 1. Fertility, Family Planning, Sexual Behavior, & Reproductive Health 1