Global Health Observatory (GHO)

Towards equitable universal health coverage in reproductive, maternal and child health services

National average gap in health service coverage and within-country wealth-related inequality in coverage gap are shown in 42 low- and middle-income countries, based on DHS and MICS data from 2005-2011.

Gap in health service coverage represents the proportion of health services that were required but not received—i.e. the increase in coverage needed to achieve universal coverage. A lower coverage gap indicates that a country is closer to achieving universal coverage. Data are based on an index that includes eight coverage indicators of maternal care, immunization, treatment of sick children and family planning.

Population attributable risk percentage is a relative measure of within-country inequality. This shows the proportional reduction in national coverage gap that would be achieved if the total population were to have the same health service coverage as the richest quintile.

Countries with low national average gap and low wealth-related inequality (the bottom left quadrant of the graph) are closest to achieving equitable universal coverage in reproductive, maternal and child health services. Conversely, countries with high gap in coverage and high inequality (the top right quadrant of the graph) have the most progress to make.

In half of the study countries, at least 36% of needed health services were not received (national average gap). The national average gap in health service coverage ranged from 15.9% to 61.2%.

For the majority of study countries (37 out of 42 countries), the national average gap could be reduced by one quarter or more if the whole population had the same coverage as the richest quintile (i.e. eliminating within-country inequality); in four countries, national average gap could be halved.

Middle-income countries tended to have a smaller national average gap—and thus were closer to achieving universal coverage for these services—than low-income countries. Median gap in health service coverage was 28.3% and 46.0% in middle- and low-income countries, respectively. While within-country inequality varied within middle- and low-income country groups, the median inequality was similar in both groups (33.5% and 35.6%, respectively).

National average and within-country inequality were highly associated in the middle-income country group, however, no association was observed in the low-income country group. This may suggest that the determinants of national average may not necessarily be the same as the determinants of within-country inequality.

Important considerations when interpreting the results:

  • The data were taken from surveys which were not conducted in the same year in all countries. Data reflect the situation in a country at the time of the survey which, naturally, is subject to change.
  • Estimates are subject to sample variability, typically indicated by confidence intervals. For the sake of readability, only point estimates are shown.