The LAC region has experienced a considerable improvement in maternal and child health post-2015 sustainable development agenda . Despite the progress, it is currently considered the most unequal region in the world, which represents a major challenge for the SDGs .
We explore current wealth-related inequalities in RMNCH coverage in 15 LAC countries. Our findings reveal important inequalities in maternal and child health interventions, pointing out that in some groups of the population women and children are lagging.
As shown in this study, essential preventive and curative interventions showed a monotonous pattern with lower levels in the poorest quintile. The inequality gap was greater in interventions that required a functional health system and recurrent interaction with healthcare personnel, except in immunizations. Although approximately 80% of the population benefited from the eight essential interventions, coverage of RMNCH interventions was lower than that in more than half of the poorest countries. Only Costa Rica and El Salvador reached this level in the poorest quintile. The difference between the wealthiest and the poorest was at least 9.8 percentage points in more than half of the countries. Haiti, Bolivia, Guatemala, Peru, and Nicaragua showed lower national coverage and absolute inequality above the regional median. Colombia showed greater inequality of coverage in the top quintiles despite not having a wide gap like other countries. These findings imply the need for health systems that prioritize adequate care to reduce the gaps in women and children from the poorest households  . Although the countries of the region have indeed implemented reforms to provide health services without the risk of impoverishment, an approach of social determinants and human rights that considers the dimensions of inequality is still required: income, gender, place of residence and education, among others  .
Achieving equity represents a much greater challenge for Colombia, Costa Rica, Haiti, Honduras, Mexico, and Panama than for other countries in the region, since they are part of the ten most unequal countries in the world . If wealth-related inequalities were eliminated, most countries could achieve coverage of RMNCH interventions of more than 82%. The relationship between CCI and PAR% suggests that to reduce the gap in coverage of health services, the implementation of policies and programs can be effective in addressing inequalities within each country . Policies should be focused on five areas: (i) development of health infrastructure; (ii) health promotion; (iii) health human resources; (iv) healthcare financing, and (v) quality of care   .
There is a political commitment to understanding inequalities, encompassing efforts to support the monitoring and evaluation of inequities, health policies, and systems. However, the possibilities of achieving the SDG goals will depend on the ability of countries to accelerate and maximize their achievements in well-being . The study, publication and discussion of the determinants of equity in the coverage of interventions and their impact on health contribute to increases in the effectiveness of public policies .
This study has several limitations. Coverage estimates are based on reanalyzed data from demographic surveys with a cross-sectional design. The analysis is limited to the availability of recent surveys in each country for latest situation analysis. The HEAT software does not provide enough data on the selected combination of variables to calculate CCI complex health inequality measures. Because the ICC is a group indicator, HEAT does not provide sufficient data to estimate the standard error using resampling methods . The household ranking of the wealth index may vary by year and country. Despite the limitations, our findings are based on the best method to explore gaps in care coverage between rich and poor .