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

2. WHY EVALUATE COVERAGE?

3. 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.

4. 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.

5. 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.

6. 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

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

8. HOW DO WE DEFINE COVERAGE?

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

10. 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.

11. 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

12. 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

13. COVERAGE
/GEOGRAPHIC II
GEOGRAPHIC COVERAGE

14. 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.

15. /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

16. COVERAGE
/TREATMENT

17. 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

18. CARTOGRAPHIE

19. ESTIMATES
/REGIONAL VS. NATIONA

21. COUVERTURE
/APERÇU DES MÉTHODES
Should I add this ?

22. QUESTIONS?

23. MERCI