Universal Coverage – if not now, when?

In the waning hours of 2010 several public health goals and targets come to mind –

  • Access to clean water and sanitation by 1990
  • Guinea worm eradication by 1995
  • Health for all by 2000
  • Polio eradication by 2005
  • Universal Coverage of malaria interventions by 2010
  • Millennium Development goals by 2015

As of October 2010 Nigeria had distributed long lasting insecticide-treated nets (LLINs) 14 of the 36 states and the Federal Capital Territory and about 40% of the targeted 60 million plus nets. A key challenge was, “The lack of operational funds to support campaigns in 22 states significantly resulting in undue delays in the delivery of LLINs.” More progress was made during the remaining months of the year.

road-map-progress-2.jpgWhere are we on 31st December 2010? The Roll Back Malaria Partnership’s most recent report on progress toward targets (the country road maps) is seen in the chart to the right. Intervention coverage progress is based on the number of countries that are actually implementing nets, medicines and spraying.

As can be seen the best progress comes with treatment and preventive medicines (ACTs and IPTp respectively).  Only 64% of countries have distributed at nets to at least 80% of the targets. The biggest gap in in the area of rapid diagnostic testing.

Distribution of an intervention does not mean actual coverage has been achieved. A recently reported study from Nigeria shows the challenges once nets reach the household.

Oyeyemi and colleagues found that 95.2% of households has received a net after a campaign. Unfortunately progress went downhill from there: “87.3% of the LLINs received were present in the households during the survey and 52.1% of households hung their LLINs … (and) utilization rate of a LLIN among the sampled population was 59% the previous night before the survey.”

Recent Demographic and Health and Malaria Indicator Surveys from places like Liberia, Senegal and Nigeria show that possession of a net by a household is not a guarantee that it will be used.

From the chart above we can see that efforts to attain universal coverage – or more accurately universal distribution – will have to proceed into 2011.  Distribution goals require health systems strengthening. The coverage goals will require more intensive community outreach and education to ensure these interventions are actually used.

We are achieving outputs – commodities distributed; we are struggling with outcomes – commodities used. What will we see in terms of impact by 2015 – the latest on the list of public health targets where we started this posting?

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