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Generation and evaluation of an indicator of the health system’s performance in maternal and reproductive health in Colombia: An ecological study

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  • Carlos Eduardo Pinzón-Flórez
  • Julian Alfredo Fernandez-Niño
  • Luz Mery Cardenas-Cardenas
  • Diana Marcela Díaz-Quijano
  • Myriam Ruiz-Rodriguez
  • Ludovic Reveiz
  • Armando Arredondo-López

Abstract

Objective: To generate and evaluate an indicator of the health system’s performance in the area of maternal and reproductive health in Colombia. Materials and methods: An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator’s score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. Results: The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator’s behavior was found to have an association with the unsatisfied basic needs index and women’s education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. Discussion: The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

Suggested Citation

  • Carlos Eduardo Pinzón-Flórez & Julian Alfredo Fernandez-Niño & Luz Mery Cardenas-Cardenas & Diana Marcela Díaz-Quijano & Myriam Ruiz-Rodriguez & Ludovic Reveiz & Armando Arredondo-López, 2017. "Generation and evaluation of an indicator of the health system’s performance in maternal and reproductive health in Colombia: An ecological study," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-15, August.
    • Handle: RePEc:plo:pone00:0180857
    DOI: 10.1371/journal.pone.0180857
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    References listed on IDEAS

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    1. Carlos Eduardo Pinzón-Flórez & Julián Alfredo Fernández-Niño & Myriam Ruiz-Rodríguez & Álvaro J Idrovo & Abel Armando Arredondo López, 2015. "Determinants of Performance of Health Systems Concerning Maternal and Child Health: A Global Approach," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-27, March.
    2. Ruiz-Rodríguez, Myriam & Wirtz, Veronika J. & Nigenda, Gustavo, 2009. "Organizational elements of health service related to a reduction in maternal mortality: The cases of Chile and Colombia," Health Policy, Elsevier, vol. 90(2-3), pages 149-155, May.
    3. Kritsotakis, George & Vassilaki, Maria & Chatzi, Leda & Georgiou, Vaggelis & Philalithis, Anastassios E. & Kogevinas, Manolis & Koutis, Antonis, 2011. "Maternal social capital and birth outcomes in the mother–child cohort in Crete, Greece (Rhea study)," Social Science & Medicine, Elsevier, vol. 73(11), pages 1653-1660.
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