RT Journal Article
SR Electronic
T1 Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e000762
DO 10.1136/bmjgh-2018-000762
VO 3
IS 3
A1 Andres Garchitorena
A1 Ann C Miller
A1 Laura F Cordier
A1 Victor R Rabeza
A1 Marius Randriamanambintsoa
A1 Hery-Tiana R Razanadrakato
A1 Lara Hall
A1 Djordje Gikic
A1 Justin Haruna
A1 Meg McCarty
A1 Andriamihaja Randrianambinina
A1 Dana R Thomson
A1 Sidney Atwood
A1 Michael L Rich
A1 Megan B Murray
A1 Josea Ratsirarson
A1 Mohammed Ali Ouenzar
A1 Matthew H Bonds
YR 2018
UL http://gh.bmj.com/content/3/3/e000762.abstract
AB Introduction The Sustainable Development Goals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. To meet those targets, essential health services must be scaled via integration with strengthened health systems. This is especially urgent in Madagascar, the country with the lowest level of financing for health in the world. Here, we present an interim evaluation of the first 2 years of a district-level health system strengthening (HSS) initiative in rural Madagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort.Methods We carried out a district representative household survey at baseline of the HSS intervention in over 1500 households in Ifanadiana district. The first follow-up was after the first 2 years of the initiative. For each survey, we estimated maternal, newborn and child health (MNCH) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. We evaluated changes between the two areas through difference-in-differences analyses. We estimated annual changes in health centre per capita utilisation from 2013 to 2016.Results The intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. The composite coverage index (a summary measure of MNCH coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. Improvements in coverage were substantially larger in the HSS catchment area and led to an overall reduction in healthcare inequalities. Health centre utilisation rates in the catchment tripled for most types of care during the study period.Conclusion At the earliest stages of an HSS intervention, the rapid improvements observed for Ifanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated HSS interventions on population health.