let’s talk about... coverage trenton dailey–chwalibÓg

LET’S TALK ABOUT...

COVERAGETrenton DAILEY–CHWALIBÓG

WHYEVALUATE COVERAGE?

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:

1. Severity of disease: thorough case finding and early treatment seeking

2. Compliance: a high level of compliance is necessary. This insures that the beneficiary receives a treatment of proven efficacy.

3. Defaulting: good retention from admission to cure is required.

EFFECTIVENESS COVERAGE

EFFECTIVENESS COVERAGE

Coverage is directly dependent on:

1. Severity of disease: thorough case finding and early treatment seeking to ensure that the majority of admissions are uncomplicated incident cases

2. Compliance: a high level of compliance is necessary. Coverage is indirectly dependent on compliance

3. Defaulting: coverage requires good retention from admission to cure.

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

Coverage

Treatment coverage

Direct calculation

Indirect calculation

Geographic coverage

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.

COVERAGE/TYPES I

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/TYPES II

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 COVERAGETreatment 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.

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

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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

QUESTIONS?

MERCI