Evaluation of universal health coverage for maternal health outcomes in low- and middle-income countries: a scoping review of the context, reforms and progress.

OBJECTIVES: This scoping review explores the global context, policies and programmes aimed at achieving universal health coverage (UHC) for maternal health services, focusing on progress within low- and middle-income countries (LMICs). Additionally, it maps methodological approaches and indicators used to evaluate UHC progress for maternal health. DESIGN: Scoping review methodology. DATA SOURCES: ProQuest, Scopus, Web of Science and Ovid MEDLINE were searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included were peer-reviewed studies that evaluated UHC policies, programmes and progress towards achieving UHC of maternal health services in LMICs, reported primary research and conducted in all healthcare settings. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened and appraised eligible studies using preset criteria based on a 'population-concept-context' framework. RESULTS: The initial search resulted in 959 studies of 61 articles selected in the final review. Most studies provided international (eg, Sustainable Development Goals, n=35), and national context on health system reforms related to healthcare financing and budgets (n=36). While progress was made on the coverage of maternal health services, the equity in maternal health service access was low for most studies. Both studies evaluating interventions and those not evaluating interventions reported high coverage in maternal health indicators, with antenatal care showing low coverage (n=7, 41%), skilled birth attendance (n=6, 55%) and facility delivery (n=6, 60%), while postnatal care coverage remained variable across studies. Two studies reported high coverage of caesarean section births (n=2, 100%). Studies evaluating intervention found equity improved in access and utilisation of maternal health services; conversely, evaluation without intervention for most studies identified low equity in access and utilisation of maternal health services. High inequity in determinants of maternal health outcomes was reported across studies measuring equity domains. CONCLUSIONS: Countries have many approaches to reaching UHC and tackling the problem of achieving UHC for maternal healthcare. Therefore, policymakers in LMICs must decide how to allocate limited resources to prioritise coverage, equity or quality of maternal healthcare.