Evidence of the Effect of Reproductive Health Commodity Availability on Achieving the MDGs
Publication date: 2006
Evidence of the Effect of Reproductive Health Commodity Availability on Achieving the MDGs June 1, 2006 Ali Mehryar Karim Elizabeth Bunde David O'Brien BACKGROUND To reach the MDG target for maternal mortality, an annual reduction of 5.4% is needed; the current average population-weighted decline is only 3.2%. The reduction in maternal mortality in sub-Saharan Africa is lagging further behind. Approximately 200 million women currently remain with an unmet need for safe and effective contraceptive services. Maternal health-related MDG targets could be reached by increasing utilization of key reproductive health interventions. Public health commodity availability at the service delivery point is regarded as one of the key elements for the success of public health programs. EVIDENCE Growing number of studies consistently show that contraceptive commodity availability at SDPs is an important supply side factor for utilizing family planning services. Adequate supply chain management systems are necessary to ensure commodity availability. Family planning logistics systems performance has an independent effect on contraceptive use. When drugs are available, patients have more confidence in the public health system and availability of pharmaceuticals has been shown to motivate health professionals. No evidence linking increase in maternal health care service utilization with commodity availability. RESEARCH QUESTION To what degree does product availability affect maternal and child health service utilization? Assumption: Increase in service utilization will reduce child and maternal morbidity and mortality INDICATORS INTERVENTIONS FOR REDUCING MATERNAL MORTALITY Source: Wagstaff, Adam and Mariam Claeson. The Millennium Development Goals for Health: Rising to the Challenges. 2004. The World Bank. METHODOLOGY Product availability for maternal health services at the SDPs and other supply side factors is assessed from facility surveys (Service Provider Assessment) conducted by Macro International. Maternal health care utilization is assessed from DHS. The relationship of the variation in product availability and service utilization between regions and across countries is assessed using bivariate and multivariate analysis. DATA SOURCES Service Provider Assessment (SPA) Ghana (2002) Rwanda (2001) Kenya (2004) Egypt (2002) Demographic and Health Survey (DHS) Ghana (2003) Rwanda (2000) Kenya (2003) Egypt (2000) Assumption: Facility attributes are constant across a year SAMPLE SIZE BIVARIATE ANALYSIS: ANC SPA INDICATORS DHS INDICATORS Supply Side Factors Outcomes Percentage of facilities that have quality physical exam Antenatal Care by Doctor .042 (.374) Percentage of facilities with testing capacity for urine protein Antenatal Care by Doctor .013 (.447) Percentage of facilities with testing capacity for anemia Antenatal Care by Doctor .009 (.467) Percentage of facilities where at least half the interviewed ANC providers received in-service training during past 12 months Antenatal Care by Nurse/Midwife .002 (.546) Percentage of facilities offering ANC services for 5+ days per week Blood pressure measured Blood sample .000 (.651) .000 (.889) VARIABLES MULTIVARIATE ANALYSIS Adjusted for survey design effect Controlled for: age, parity, marital status, education, wealth, urban-rural residence, country and region The bivariate relationship between supply side and demand side factors remained significant CONCLUSION Reproductive health commodity availability is associated with service utilization. Investment in logistics systems management for reproductive health commodities is essential in order to achieve MDG targets for improving maternal health. LIMITATIONS Temporal ambiguity due to cross-sectional data Endogeneity: reverse causality or simultaneity Select Interventions – highlight necessity of commodities
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