Scaling up delivery along the continuum of care

International Health | RMNCH and nutrition: our experience

Scaling up delivery along the continuum of care The unique complexities of service integration and continuity call for rigour and extensive systems knowledge.

The benefits of integrated delivery for unlocking the interrelated challenges of reproductive, maternal, newborn and child health and nutrition are widely known.

However, identifying the connections on the ground and then converting opportunities into scalable interventions along an uninterrupted continuum is complex.

The continuum of care

The continuum of care applies to services delivered to individuals over specific periods of their life, such as health education during adolescence or neonatal care after childbirth.

We unpack and address systemic challenges affecting adolescent reproductive health, family planning, antepartum, intrapartum and postpartum care, early childhood development, and nutrition.

It also refers to services offered at different tiers of the health system, from community-based care to outpatient clinics and hospital services. To be effective, these need to be delivered in a rational and well-coordinated way that maximises and balances the competing demands of access, efficiency and need for specialist skill.

There are many opportunities to overlap services and synchronise interventions but, for optimum effectiveness, services must put clients at the centre and use any contacts or entry points with the health system to promote services, such as offering family planning or nutrition counselling during postnatal checks or during consultations for child illness.

At Mott MacDonald, we understand that successful integration of services depends on strong health systems characterised by effective stewardship, meaningful and accessible information systems, sound finance mechanisms and efficient use of human resources.

We bring decades of experience in strengthening systems to sustain quality care for healthier mothers and children, whenever and wherever needed. In Africa and Asia, we have worked closely with governments, agencies and NGOs to gain a deep understanding of the systemic, cultural and political barriers that can stand in the way of effective delivery at scale.

Alongside technical expertise in family planning, nutrition and maternal, newborn and child health, we also provide advice and guidance in related sectors such as education, women’s empowerment, socio-economic development, water sanitation and hygiene, and waste management.

Supporting community midwives Increasing access to family planning “If we think of the continuum of care as a spiral that stretches up from mother to child, and then beyond, there are many opportunities to overlap services. The work is challenging. You must combine technical know-how with a feel for local politics. But the effort is worthwhile. Every successful intervention will help build a stronger foundation for generations to come.”

Lucy Palmer Key account leader for MNCH and nutrition

Intrapartum care

Gates landscape analysis

Family planning

Our projects

Adolescent health Nutrition

Maternal, newborn and child health

Supporting adolescent girls in Zambia Health financial management

Postpartum newborn care

Food fortification Early Childhood Girls’ education

Making access to clean water a reality

Our project experience

Empowering adolescent girls in Zambia, 2012-2016 We were the independent evaluator of the UK aidfunded adolescent girls empowerment programme in Zambia. We tested the ‘Safe Spaces’ model to understand if it improved sexual and reproductive health and empowerment for poor and vulnerable adolescent girls. We identified opportunities for strengthening several aspects of the approach, including customising the curriculum for different ages, developing strategies to improve attendance and increase inclusion, supporting the role of mentors, and improving community engagement.

Making access to clean water a reality in South Sudan, 2013-2019 The Water for Lakes programme, funded by the Government of the Netherlands, is putting water management in the hands of the people who rely on this precious resource for their health and livelihoods.

We work closely with the local communities to stimulate economic development through the management of water resources and reduce disease and illness through training in hygiene and safe water handling practices.

Increasing access to family planning in Nepal, 2013-2016 The UK Department for International Development asked us to evaluate the effectiveness, efficiency and impact of a range of innovative family planning interventions targeting those with known low access.

Working in Nepal with local partner HERD, we assessed three pilot family planning initiatives for women and men living in hill districts and documented the nature of gaps and barriers to services.

Health financial management in Pakistan, TRF+, 2015-2019 A major focus of TRF+ has been creating a more secure financial base for government investment in maternal and child health. Budgeting processes in Punjab and Khyber Pakhtunkhwa are now more robust, and there’s been a reduction of more than an 80% in both supplementary grants and re-appropriations, directly contributing to improved service delivery and greater use.

Community midwives in Pakistan, TRF+, 2015-2019 Our management of the Technical Resource Facility – known as TRF+ and part of the UK aid-funded Provincial Health and Nutrition Programme in Punjab and Khyber Pakhtunkhwa – has supported important policy interventions to attract more community midwives in areas where skilled birth attendance is low. The measures include expanding midwives’ scope of work to mental health and family planning, and linking services with performance-based incentives.

Girls’ education in South Sudan, 2013-2018 Our education specialists Cambridge Education implemented the UK aid-funded Girls’ Education South Sudan programme, transforming the lives of 200,000 girls. We worked with local organisations to address the cultural, economic, environmental and logistical barriers preventing girls from enrolling and staying in school.

Intrapartum care in Kenya, Uganda and India, 2015-2017 We were commissioned by the Bill and Melinda Gates Foundation to undertake a landscape analysis of intrapartum care, a critical period for maternal mortality. We found that, while quality improvement for delivery care was on national agendas, it was donors rather than governments who were driving this. A lack of resources meant the increased demand that accompanied service improvements could not be met, causing staff engagement to decline after the initial enthusiasm. Delivery of patient-centred care requires a combination of behaviour change initiatives and government commitment to sustain transition.

Food fortification in Pakistan, 2016-2021 We lead the Food Fortification Programme (FFP) in Pakistan, a nationwide programme to fortify all commercially produced wheat flour and oil/ghee.

FFP provides technical assistance to laboratories, government bodies and industry, supporting them to introduce regulatory enforcement mechanisms and achieve sustainable benefits among the next generation.

Health interventions help to educate health workers and young mothers about the nutritional benefits of fortified products.

Opening opportunities with connected thinking.

For more info contact health@mottmac.com mottmac.com