# Effective coverage measurements and cascade for maternal, newborn, child and adolescent health in high-income countries: systematic review

## TL;DR

This review looked for how effective coverage is measured in maternal, newborn, child, and adolescent health in high-income countries but found no relevant studies.

## Contribution

The first systematic review to explore effective coverage application in high-income countries for MNCAH.

## Key findings

- No studies met the inclusion criteria for effective coverage in HICs.
- Additional searches also failed to identify relevant HIC-focused research.
- The review highlights a gap in applying effective coverage concepts in high-income settings.

## Abstract

The concept of ‘effective coverage’ (EC) aims to combine the concept of coverage with the quality of care delivered and, ultimately, the health benefits received by the population in need. To date, systematic reviews of EC of maternal, newborn, child and adolescent health (MNCAH) have focused on low- and middle-income countries (LMICs). No review has examined whether and how the concept has been applied in high-income countries (HICs). To address this gap, this systematic review investigated the application of EC measures in MNCAH care in HICs.

This was a systematic review that followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. The search strategy was developed from previous EC reviews conducted in LMICs and further adapted to the HIC setting. Additional search terms were identified through discussion with experts from the Life Stage Quality of Care Metrics Technical Working Group subgroup on EC. We searched three databases, PubMed, Embase, and Web of Science, over 10 years. We conducted additional searches in Google Scholar and by consulting members of the Life Stage Quality of Care Metrics Technical Working Group. We did not pose any language or type of article limits.

The database search identified 18 976 studies for screening. Of these, 672 abstracts were screened, and none of the full texts considered met our inclusion criteria (e.g. human immunodeficiency virus/hepatitis c virus continuum of care cascade, intervention type, qualitative search-interviews/questionnaire type studies). Thirty-two articles were retrieved through the additional search strategies, and none were included because of LMIC-focused research. Therefore, examples of EC of MNCAH care applied in HICs were not identified.

Further investigation should be conducted into the application of the EC concept for assessing MNCAH care in HICs. This research will help us understand how this concept can be used to support health system effectiveness, efficiency, and equity in HICs.

The study protocol was registered at the Open Science Framework: https://doi.org/10.17605/OSF.IO/FMCG8.