LET’S TALK ABOUT... COVERAGE Trenton DAILEY–CHWALIBÓG

WHY EVALUATE COVERAGE?

NEW APPROACH → NEW INDICATOR EVALUATE /MET NEED NEW APPROACH → NEW INDICATOR Yesterday: Efficacy Efficacy of the CMAM protocol is defined by how well it works in controlled conditions*. Example: 95% cure rate, 5% default rate Today: Effectiveness The cure rate of a beneficiary cohort under program conditions. We are unable to greatly improve efficacy; however, we can improve effectiveness.

EFFECTIVENESS EFFECTIVENESS Effectiveness depends on: Severity of disease: thorough case finding and early treatment seeking Compliance: a high level of compliance is necessary. This insures that the beneficiary receives a treatment of proven efficacy. Defaulting: good retention from admission to cure is required.

EFFECTIVENESS COVERAGE Coverage is directly dependent on: Severity of disease: thorough case finding and early treatment seeking to ensure that the majority of admissions are uncomplicated incident cases Compliance: a high level of compliance is necessary. Coverage is indirectly dependent on compliance Defaulting: coverage requires good retention from admission to cure.

Met need = Effectiveness × Coverage EVALUATING /MET NEED Met need = Effectiveness × Coverage Meeting need requires both high effectiveness and high coverage; and, coverage and effectiveness depend on the very same things, therefore: Effective programs have high coverage High coverage programs have high cure rates

EVALUATING /MET NEED II Let’s look at how programs with low coverage fail to meet need.

HOW DO WE DEFINE COVERAGE?

EQUATIONS TYPES OF COVERAGE OVERALL COVERAGE Treatment coverage Direct calculation Indirect calculation Geographic coverage

GEOGRAPHIC VS. TREATMENT COVERAGE /TYPES I GEOGRAPHIC VS. TREATMENT GEOGRAPHIC COVERAGE Measures service availability for the treatment of SAM TREATMENT COVERAGE Measures the service access and uptake for the treatment of SAM ...not only are these two definitions of coverage different, but they are used for different means.

GEOGRAPHIC VS. TREATMENT COVERAGE /TYPES II GEOGRAPHIC VS. TREATMENT GEOGRAPHIC COVERAGE Is used as a process indicator to measure the scale- up and decentralization of SAM treatment services TREATMENT COVERAGE Is used as an impact indicator to evaluate the extent to which available CMAM services successfully reach a high proportion of SAM cases

COVERAGE /GEOGRAPHIC I GEOGRAPHIC COVERAGE The proportion of administrative divisions (a health district or a health zone, for example) providing CMAM services to the total number of service delivery units The proportion of health centers in a region (or country) providing CMAM services to the total number of health centers in the region

COVERAGE /GEOGRAPHIC II GEOGRAPHIC COVERAGE

COVERAGE /TREATMENT TREATMENT COVERAGE Treatment coverage can be measured either directly or indirectly. It is defined as: the proportion of all people needing or eligible to receive a service that actually receive that service.

/INDIRECT CALCULATION COVERAGE /TREATMENT /INDIRECT CALCULATION INDIRECT CALCULATION The expected SAM caseload is subject to much variation The under 5 population estimate is not always reliable

COVERAGE /TREATMENT

The nutrition sector was pushed to develope an alternative method to indirect coverage calculations, that was neither based on prevalence nor on population estimates... SQUEAC

CARTOGRAPHIE

ESTIMATES /REGIONAL VS. NATIONA

COUVERTURE /APERÇU DES MÉTHODES Should I add this ?

QUESTIONS?

MERCI