ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2020) 17 13.3 | DOI: 10.1530/ey.17.13.3

ESPEYB17 13. Global Health for the Paediatric Endocrinologist Advocacy, History and Society (5 abstracts)

13.3. Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: Progress, future prospects, and implications for quality health systems

Marsh AD , Muzigaba M , Diaz T , Requejo J , Jackson D , Chou D , Cresswell JA , Guthold R , Moran AC , Strong KL , Banerjee A , Soucat A & on behalf of the Effective Coverage Think Tank Group


Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Department of Health Systems Governance and Financing; Department of Sexual and Reproductive Health and Research including the UNDPUNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland; Division of Data, Analysis, Planning and Monitoring and Health Division, United Nations Children’s Fund, Headquarters, School of Public Health, University of the Western Cape, Cape Town, South Africa tdiaz@who.int


To read the full abstract: Lancet Glob Health 2020; 8: e730–36. doi: 10.1016/S2214-109X(20)30104-2

• Sustainable Development Goals (SDG) were adopted by United Nations Member States in 2015. Universal health coverage is at the centre of SDG #3 but lacks metrics that make it possible to assess how effective the provided healthcare is.• WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to develop a consensus on the definition and measurement of effective health coverage for maternal, newborn, child, and adolescent health and nutrition.• The Group developed a 7-step standardised cascade for the measure of effective coverage that can be applied to various practical situations.

In addition to providing clinical care for patients (and families) with endocrine diseases and with diabetes, pediatric endocrinologists often need to serve as advocates for their patients and their families, especially in settings where universal health coverage does not exist. This is often a difficult task that goes beyond the subspecialty training they receive. The 7-step cascade developed by the Think Tank Group in this article is useful to guide pediatric endocrinologists in their journey as an advocate for their patients. Several practical examples are developed by the authors. Using Type 1 diabetes care as an example, the cascade could be described as follows. Step 1 (target population) consists in identifying the population of children with diabetes (for instance, by improving the diagnosis and by the development of a registry); Step 2 (service contact coverage) consists in determining the proportion of children with diabetes who actually come in contact with the (relevant) health service (for instance, the patient may be known but may not have access to a diabetes team for various reasons such as travel distance, lack of education or poverty); Step 3 (input adjusted coverage) investigates whether the team accessed by the patient is ready to provide the expected care (for instance, there may be insufficient staffing or suboptimal training); Step 4 (intervention coverage) ensures that patients with Type 1 diabetes who come in contact with a diabetes team actually receive the service (for instance follow up may not be available in a timely fashion or language barriers may prevent provision of care); Step 5 (quality-adjusted coverage) determines whether the care is provided according to the expected standards (for instance, the team may not provide care according to internationally-recognized standards such as the ISPAD guidelines or to locally available standards developed for the specific environment of the patient); Step 6 (user adherence-adjusted coverage) assesses whether children with diabetes adhere to provider instructions; Step 7 (outcome-adjusted coverage) investigates whether the provision of optimal care and good adherence to the recommendations actually result in the expected health outcome (for instance, prevention of diabetic complications, decrease in admissions for diabetes keto-acidosis). This framework will be useful to pediatric endocrinologists trying to define a clear process to optimize support for their patients and families with Type 1 diabetes and can be applied to many of our patient groups.

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