Canais de prestação de serviços e a magnitude de desigualdades na cobertura de intervenções SRMNC: uma análise de 36 inquéritos transversais em países de renda baixa e média

Abstract

Background: Inequalities in coverage of reproductive, maternal, newborn and child health (RMNCH) interventions have been the topic of several international reports, but little is known about said interventions’ ranking in terms of inequality across multiple low and middle-income countries (LMICs). Methods: We analyzed data from 36 LMICs, for which national surveys carried out since 2010 provided information on a set of 18 RMNCH interventions, which were classified into four delivery channels: health-facility based, community based, environmental and culturally driven. For a subset of 21 countries, information was also available on malaria interventions. Within each country, wealth quintiles were derived from information on household asset indices. Absolute and relative inequalities were assessed using the slope index of inequality (SII) and the concentration index (CIX). Countries were classified as either low- or middle-income. Findings: All interventions tended to present pro-rich patterns, except for two breastfeeding indicators classified in the culturally driven group, which tended to have higher coverage among the poor. The most unequal set of interventions were in the environmental group, particularly use of clean fuels. Interventions essentially delivered in health facilities, such as institutional childbirth and antenatal care, also tended to show marked pro-rich patterns, whereas those that also relied on community channels (such as immunizations and oral rehydration) were more equitably distributed. Interpretation: Interventions delivered at community level tend to be more equitable than those delivered in fixed facilities or those that require changes in the home environment. Policymakers need to learn from community delivery channels in order to promote more equitable access to all RMNCH interventions.