Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunity

Abstract

The proportion of women and childrenreceiving health care in the poorest coun-tries is increasing [1]. Unfortunately, mark-ers of improved health outcomes, such asfalling maternalornewbornmortality,havenot matched expectations from the gains inthe coverage of care.Robust evidenceexistsfor one explanatory factor: the poor–richgaps in coverage found along the continu-um of care for women and children, andparticularly for the crucial period aroundchildbirth [2]. The more-neglected expla-nation for the mismatch between coverageand health outcomes is the quality of thecare provided to women and children,which isthefocus of Year 1 of the MaternalHealth Task Force (MHTF)-PLOS Collec-tion on Maternal Health (http://www.ploscollections.org/maternalhealth_year1)and our short commentary.Although inadequacies in care havelong been noted across the world and formany health problems [3], a focus on themagnitude, costs, and consequences spe-cifically for women and children in low-income countries is relatively new, and stillhas not achieved the status of a politicalpriority [4]. This contrasts markedly withthe attention paid to the coverage of care.Here we seek to highlight the synergiesbetween inequalities in coverage andquality. The inverse care law [5] proposesthat quality of care varies inversely withneed, and we extend this to emphasizethat poor quality care is disproportionatelyborne by the poorest groups of womenand children. Our commentary is struc-tured around a key cause and a conse-quence of the neglect of quality—weakmeasurement and poor evidence foraction—and concludes with priorities forseizing the quality care opportunity.

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