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

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

2. WHYEVALUATE COVERAGE?

3. 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. EFFECTIVENESSCOVERAGE • EFFECTIVENESSCOVERAGE • Coverage is directly dependenton: • 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. 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?

10. 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. 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. 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 sectorwaspushed to develope an alternative method to indirect coveragecalculations, thatwasneitherbased on prevalencenor on population estimates...SQUEAC

18. CARTOGRAPHIE

19. ESTIMATES /REGIONAL VS. NATIONA

21. COUVERTURE /APERÇU DES MÉTHODES

22. QUESTIONS?

23. MERCI