Key concepts Scenario Analysis

Bottleneck Reduction Value

To assess a realistic pace at which bottlenecks for the deprived populations could be reduced an analysis of 54 countries was carried out. For each country and each coverage determinant, we calculated the bottleneck severity in 2 periods of time based on data availability – the period corresponding to the most recent household survey and the previous household survey available (normally corresponding to pre-2010 & post 2010). The analysis was done separately for each platform using indicators previously described.

Table 7: Calculation of bottleneck severity

Determinant/Bottleneck Calculation of Bottleneck Severity
Availability of commodities 100% – value of determinant
Geographic Access
Financial Affordability
Socio-cultural Acceptability
Continuity Relative drop between Initial Utilization and Adequate Coverage: (IU-AC)/IU
Quality Relative drop between Adequate Coverage and Effective Coverage: (AC-EC)/IU


We then estimated change over time with the relative reduction in the bottleneck

Relative bottleneck reduction = (Endline-Baseline)/Baseline

This provided an estimation of the performance of countries in their ability to overcome bottlenecks to improve the effective coverage. Based on their performance in reducing bottlenecks, we ranked the countries from highest to lowest bottleneck reduction for each determinant and per service delivery mode. We grouped the countries averaging the bottleneck reduction of the 1/3 of countries with best performance.[1]

In addition, note that for geographical access, financial affordability, and sociocultural acceptability in preventive services and curative/clinical services, the estimation was based on “problems accessing care” from DHS, for a subset of countries with DHS at the baseline and endline.   Finally, to ensure consistency on the assessment of bottlenecks before and since 2010, we only used indicators for which comparable information was available before and since 2010, using country data available. Therefore, as country data availability varies by country, different countries may be using different indicators to assess performance.


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