@article{fdi:010080482,
  title = {{D}istrict-level health system strengthening for universal health coverage : evidence from a longitudinal cohort study in rural {M}adagascar, 2014-2018},
  author = {{G}architorena, {A}ndres and {M}iller, {A}. {C}. and {C}ordier, {L}. {F}. and {R}andriamanambintsoa, {M}. and {R}azanadrakato, {H}. {T}. {R}. and {R}andriamihaja, {M}. and {R}azafinjato, {B}. and {F}innegan, {K}. {E}. and {H}aruna, {J}. and {R}akotonirina, {L}. and {R}akotozafy, {G}. and {R}aharimamonjy, {L}. and {A}twood, {S}. and {M}urray, {M}. {B}. and {R}ich, {M}. and {L}oyd, {T}. and {S}olofomalala, {G}. {D}. and {B}onds, {M}. {H}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {D}espite renewed commitment to universal health coverage and health system strengthening ({HSS}) to improve access to primary care, there is insufficient evidence to guide their design and implementation. {T}o address this, we conducted an impact evaluation of an ongoing {HSS} initiative in rural {M}adagascar, combining data from a longitudinal cohort and primary health centres. {M}ethods {W}e carried out a district representative household survey at the start of the {HSS} intervention in 2014 in over 1500 households in {I}fanadiana district, and conducted follow-up surveys at 2 and 4 years. {A}t each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the {HSS} intervention and control catchments. {W}e used logistic regression models to evaluate changes associated with exposure to the {HSS} intervention. {W}e also estimated changes in health centre per capita utilisation during 2013 to 2018. {R}esults {C}hild mortality rates decreased faster in the {HSS} than in the control catchment. {W}e observed significant improvements in care seeking for children under 5 years of age ({OR} 1.23; 95% {CI} 1.05 to 1.44) and individuals of all ages ({OR} 1.37, 95% {CI} 1.19 to 1.58), but no significant differences in maternal care coverage. {E}conomic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators. {C}onclusion {T}he results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a {HSS} intervention in rural {M}adagascar. {A}dditional improvements in this context of persistent geographical inequalities will require a stronger focus on community health.},
  keywords = {health systems ; child health ; health services research ; maternal health ; cohort study ; {MADAGASCAR}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {5},
  numero = {12},
  pages = {e003647 [15 p.]},
  ISSN = {2059-7908},
  year = {2020},
  DOI = {10.1136/bmjgh-2020-003647},
  URL = {https://www.documentation.ird.fr/hor/fdi:010080482},
}