Effective Coverage and Its Application in the Thai Context

Abstract

Effective coverage is a concept of measuring health gain which incorporates health needs, utilization of health services, and the benefits to patients from using them into a single metric. In the past two decades, the World Health Organization and other agencies advocated the use of effective coverage as a way to assess health systems performance and track outcomes of universal health coverage. Two main objectives of this paper were to review literature relevant to definition, methodologies, and internation­al and domestic experience; and to synthesize the recommendations for effective coverage assessment in the Thai context. The literature review found discrepancies of definition and measurement across various studies which caused confusions in communication, comparison and interpretation of the results. The authors proposed that Thailand should apply the definition of ‘the proportion of a population in need of a service that had a positive health outcome from using the service’. This definition communi­cated clearer meaning and reduced methodological complexities. Selection of proxy interventions should be guided by national health priorities, the possibility of making a positive change in the coverage and health gain, and reliable data sources. Key challenges of measuring effective coverage include defining operational criteria, understanding data requirement and results of low coverage as well as inequity dimensions across sub-population groups. Stakeholder participatory process of effective coverage monitoring should improve policy usefulness.