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