title: Towards universal health coverage: the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa.
abstract: OBJECTIVE
  To measure within-country wealth-related inequality in the health service coverage gap of maternal and child health indicators in sub-Saharan Africa and quantify its contribution to the national health service coverage gap.
  
  
  METHODS
  Coverage data for child and maternal health services in 28 sub-Saharan African countries were obtained from the 2000-2008 Demographic Health Survey. For each country, the national coverage gap was determined for an overall health service coverage index and select individual health service indicators. The data were then additively broken down into the coverage gap in the wealthiest quintile (i.e. the proportion of the quintile lacking a required health service) and the population attributable risk (an absolute measure of within-country wealth-related inequality).
  
  
  RESULTS
  In 26 countries, within-country wealth-related inequality accounted for more than one quarter of the national overall coverage gap. Reducing such inequality could lower this gap by 16% to 56%, depending on the country. Regarding select individual health service indicators, wealth-related inequality was more common in services such as skilled birth attendance and antenatal care, and less so in family planning, measles immunization, receipt of a third dose of vaccine against diphtheria, pertussis and tetanus and treatment of acute respiratory infections in children under 5 years of age.
  
  
  CONCLUSIONS
  The contribution of wealth-related inequality to the child and maternal health service coverage gap differs by country and type of health service, warranting case-specific interventions. Targeted policies are most appropriate where high within-country wealth-related inequality exists, and whole-population approaches, where the health-service coverage gap is high in all quintiles.
authors.affiliation: Department of Health Statistics and Informatics, World Health Organization, Avenue Appia 20, Geneva 27, Switzerland. hosseinpoora@who.int
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Hosseinpoor
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.forename: Nicole
authors.initials: N
authors.lastname: Bergen
authors.forename: Aluisio J D
authors.initials: AJ
authors.lastname: Barros
authors.forename: Ties
authors.initials: T
authors.lastname: Boerma
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D002648:Child; D002669:Child Welfare; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D038622:Internationality; D008429:Maternal Welfare; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D019472:Universal Health Insurance / Q000191:economics* / Q000706:statistics & numerical data; D055815:Young Adult