Introduction

CHAPTER 2

Effective Coverage: A Framework Linking Coverage and Quality

Introduction

For a long time, large international initiatives like the Millennium Development Goals focused on increasing health service coverage, defined as the rate of people in need of medical care who obtain treatment from a formal health care provider. This approach is increasingly questioned because it ignores the quality of care, which is often very low, especially for the poor. There is growing evidence that health conditions are often misdiagnosed and even when the diagnosis is correct, the appropriate treatment or interventions might not be prescribed or implemented (Das, Hammer, and Leonard 2008). This chapter focuses on how the concept of effective coverage aims at providing a bridge between health coverage and quality of care, requiring that persons in need get the treatment that maximally improves their health.

The chapter shows how effective coverage can be decomposed into the product of coverage (those in need getting care) and quality (correct or successful treatment among those getting care). It also presents estimates of effective coverage and its two components for six common medical conditions (pregnancy, child malaria, child diarrhea, hypertension, tuberculosis [TB], and HIV), using household survey data. These examples illustrate the roles of coverage and quality as bottlenecks to better effective coverage and the degree to which their importance varies by medical condition and country. Finally, the chapter discusses the benefits and disadvantages of household and facility survey data in measuring effective coverage and how facility-based data could be used to expand the set of effective coverage measures.