Abstract:
BACKGROUND: Inequity in access to and use of child and maternal health
interventions is impeding progress towards the maternal and child health
Millennium Development Goals. This study explores the potential health gains and
equity impact if a set of priority interventions for mothers and under fives were
scaled up to reach national universal coverage targets for MDGs in Tanzania.
METHODS: We used the Lives Saved Tool (LiST) to estimate potential reductions in
maternal and child mortality and the number of lives saved across wealth
quintiles and between rural and urban settings. High impact maternal and child
health interventions were modelled for a five-year scale up, by linking
intervention coverage, effectiveness and cause of mortality using data from
Tanzania. Concentration curves were drawn and the concentration index estimated
to measure the equity impact of the scale up.
RESULTS: In the poorest population quintiles in Tanzania, the lives of more than
twice as many mothers and under-fives were likely to be saved, compared to the
richest quintile. Scaling up coverage to equal levels across quintiles would
reduce inequality in maternal and child mortality from a pro rich concentration
index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration
index of -0,03 and -0.03 respectively. In rural areas, there would likely be an
eight times greater reduction in maternal deaths than in urban areas and a five
times greater reduction in child deaths than in urban areas.
CONCLUSIONS: Scaling up priority maternal and child health interventions to equal
levels would potentially save far more lives in the poorest populations, and
would accelerate equitable progress towards maternal and child health MDGs.
