How effective coverage has been used to measure quality in maternal and child health services in sub-Saharan Africa: a scoping review

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Objectives: This study aimed to evaluate how effective coverage has been used to measure healthcare quality of maternal and child health services in Sub-Saharan Africa (SSA). Design: Scoping review. Data sources: We systematically searched five indexed databases and grey literature for studies published from 1 January 2000 to 30 April 2025. Eligibility criteria: All articles on global policy and those conducted in SSA were considered. All original articles that reported measuring effective coverage based on the WHO framework for maternal, newborn and child health were included in the review. Abstracts presented at meetings and conferences were eligible for inclusion. Other studies on 'Health care quality' were also considered. Data extraction and synthesis: We charted study characteristics, Maternal and Child Health (MCH) services, routine use and quality domains and compared crude service coverage with effective coverage. A descriptive synthesis and thematic analysis were conducted. Results: 21 studies met the inclusion criteria; 66.7% (n=14) were from East Africa, indicating poor and disproportionate use of effective coverage across SSA. Most studies on effective coverage used cross-sectional (n=19, 90.5%) and ex-post (n=12, 57.1%) data. Effective coverage lagged behind CC, thus revealing quality gaps. Despite the failures of health systems to adopt routine measurement of effective coverage, few studies (n=4) relied on data from national health registries to explore effective coverage. The review also noted mixed inequities in effective coverage with women from wealthier groups often benefiting the most in institutional deliveries as compared with their poor counterparts. This varied in the uptake in the case of antenatal and postnatal care services among users. The review has also revealed variability in the quality measures used to compute effective coverage. Conclusions: Effective coverage is critical for evaluating MCH service quality in SSA. Its underuse signals the need for stronger data systems, integrated quality assessment frameworks and standardised quality measures.

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