@article{fdi:010073723,
  title = {{E}arly changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in {M}adagascar},
  author = {{G}architorena, {A}ndres and {M}iller, {A}. {C}. and {C}ordier, {L}. {F}. and {R}abeza, {V}. {R}. and {R}andriamanambintsoa, {M}. and {R}azanadrakato, {H}. {T}. {R}. and {H}all, {L}. and {G}ikic, {D}. and {H}aruna, {J}. and {M}c{C}arty, {M}. and {R}andrianambinina, {A}. and {T}homson, {D}. {R}. and {A}twood, {S}. and {R}ich, {M}. {L}. and {M}urray, {M}. {B}. and {R}atsirarson, {J}. and {O}uenzar, {M}. {A}. and {B}onds, {M}. {H}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {T}he {S}ustainable {D}evelopment {G}oals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. {T}o meet those targets, essential health services must be scaled via integration with strengthened health systems. {T}his is especially urgent in {M}adagascar, the country with the lowest level of financing for health in the world. {H}ere, we present an interim evaluation of the first 2 years of a district-level health system strengthening ({HSS}) initiative in rural {M}adagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort. {M}ethods {W}e carried out a district representative household survey at baseline of the {HSS} intervention in over 1500 households in {I}fanadiana district. {T}he first follow-up was after the first 2 years of the initiative. {F}or each survey, we estimated maternal, newborn and child health ({MNCH}) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. {W}e evaluated changes between the two areas through difference-in-differences analyses. {W}e estimated annual changes in health centre per capita utilisation from 2013 to 2016. {R}esults {T}he intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. {T}he composite coverage index (a summary measure of {MNCH} coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. {I}mprovements in coverage were substantially larger in the {HSS} catchment area and led to an overall reduction in healthcare inequalities. {H}ealth centre utilisation rates in the catchment tripled for most types of care during the study period. {C}onclusion {A}t the earliest stages of an {HSS} intervention, the rapid improvements observed for {I}fanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated {HSS} interventions on population health.},
  keywords = {{MADAGASCAR}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {3},
  numero = {3},
  pages = {art. e000762 [12 ]},
  ISSN = {2059-7908},
  year = {2018},
  DOI = {10.1136/bmjgh-2018-000762},
  URL = {https://www.documentation.ird.fr/hor/fdi:010073723},
}