Maternal, Newborn, and Child Health

Mother with baby

In the last 20 years, great strides have been made in reducing child and maternal deaths.  However, child and maternal deaths still remain unacceptably high. In 2013, 6.3 million children died before their fifth birthday, and even now some 800 women and girls die each day in the process of giving life, largely from preventable causes. Strengthening essential system functions to reliably deliver high quality, life-saving interventions for leading causes of maternal, newborn, and child mortality is a major part of USAID’s Ending Preventable Child and Maternal Deaths (EPCMD) strategy. The USAID ASSIST Project supports the global EPCMD agenda by:

  • Testing and implementing innovative, cutting-edge quality improvement and service delivery approaches in maternal, newborn, and child health (MNCH), such as collaborative improvement, process redesign, and integrating routine and complications care across system levels
  • Developing, testing, and disseminating technical frameworks, approaches, and tools that can increase the efficiency, effectiveness, cost-effectiveness and sustainability of health system strengthening and quality improvement initiatives in support of the USAID EPCMD strategy, including strategies to integrate gender considerations in care delivery
  • Building government and implementing partner capacity to apply improvement methods across health system levels (community, clinic, hospital, district, regional, central) to improve, scale up, and sustain high-impact, low-cost, people-centered MNCH and family planning (FP) services for leading causes of maternal newborn and child morbidity and mortality in USAID priority countries
  • Strengthening frontline health worker and manager skills, motivation, and performance through integrated clinical and quality improvement (QI) capacity building and through engagement of health workers in making improvements in their local health care systems and processes
  • Supporting the development and testing of MNCH quality of care indicators, strengthening routine health information systems to enable regular tracking of quality measures at service delivery level, and promoting accountability at global, national, and sub-national levels

Drawing on extensive experience support the planning, implementation and evaluation of MNCH improvement programs in different countries and regions, USAID ASSIST also contributes to global learning about gaps in care processes and how to best support health system functions to deliver high-impact, cost-effective MNCH services to decrease preventable maternal and child deaths.

MCHIP Project close-out event: Lessons learned and the way forward

Elizabeth Romanoff Silva

USAID ASSIST Project/WI-HER

Last Thursday, June 26th marked the end of USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) with the conference, “Critical Concepts for Ending Preventable Child and Maternal Deaths.” The event in Washington DC highlighted program learning and recommendations on scale up, quality, and community from the six-year USAID project. The event was attended by more than 400 development practitioners from many countries, including 23 health ministers from USAID-supported countries. Highlights from the conference included an overview of MCHIP’s achievements and lasting impact by Project Director Koki Agarwal and a panel discussion between five African Health Ministers about acting on preventable child and maternal deaths.

Integrating improvement methodology into the Essential Care for Every Baby (ECEB) Protocol

Jorge Hermida

Senior QI Advisor, MNCH, and Latin America Regional Director, USAID ASSIST Project/URC

In May I had the pleasure of participating in and presenting at the Essential Care for Every Baby (ECEB) workshop, on behalf of URC and the USAID ASSIST Project in Addis Ababa, Ethiopia. The four -day workshop was organized jointly by USAID, MCHIP, the American Academy of Pediatrics, Save the Children, and the Laerdal Foundation. The objective was to introduce nearly 100 delegates from MOHs and cooperating agencies from 10 African countries to this newly developed training program on essential newborn care based on latest WHO guidelines.

The Lancet offers the clearest picture on progress in newborn survival

Faith Mwangi-Powell

Chief of Party, Kenya, USAID ASSIST Project/URC

Termed as “the clearest picture on the ongoing slow progress to infant survival”, in its recent series - Every Newborn - The Lancet offers tangible guidance on post-2015 targets and opportunities that can enhance every newborn’s healthy start in life.  Based on evidence from over 18 countries and written by 55 experts from 29 institutions, this series provide an evidence base for a global action plan for addressing issues that impact newborn survival.

Message from a Senior Midwife for International Day of the Midwife

Annie Clark

Senior QI Advisor MNCH, USAID ASSIST Project/URC

This message from Annie Clark, Senior QI Advisor for MNCH, was originally posted on URC's website to commemorate the International Day of the Midwife, which was celebrated on May 5.

To all my sister and brother midwives, I wish you a Happy International Day of the Midwife! My favorite term for midwife is the French phrase, “sage femme,” meaning “wise woman,” an apt description for the midwives I have worked with all over the world.

Improving Essential Newborn Care in Uganda

Annie Clark

Senior QI Advisor MNCH, USAID ASSIST Project/URC

In Uganda, the MoH requested that the Health Care Improvement Project (HCI) improve essential newborn care (ENC), including newborn resuscitation utilizing the Helping Babies Breathe (HBB) methodology and tools, in Luwero and Masaka districts. I was privileged to provide technical assistance to the HCI Uganda team to respond to the MoH request. 

Keeping mothers and babies in care to eliminate transmission of HIV

Nigel Livesley

Regional Director for South Asia, USAID Applying Science to Strengthen and Improve Health Systems (ASSIST) Project, University Research Co., LLC (URC)

My colleagues in Uganda are working with rural clinics to improve their capacity to prevent mother-to-child transmission of HIV.  Recently, we visited one rural clinic whose records showed that 177 exposed babies had been born in the clinic or had come there for care at some point in the past 18 months.  Yet only 9 had come back to the clinic in April 2013.

Improving uptake and retention of PMTCT services

Rhea Bright

Quality Improvement & Human Resources for Health Advisor, USAID Bureau for Global Health Office of Health Systems
AIMGAPS nurse explains CHSS in Tanzania

An AIMGAPS facility nurse explains the Community Health Systems Strengthening Model (CHSS) to her colleagues during a training session in Iringa, Tanzania, where these nurses are being prepared to serve as community QI coaches for their catchment areas.

Photo by Rhea Bright, URC

Under the USAID Health Care Improvement Project (HCI), my colleagues in Tanzania and I have been working with the Ministry of Health and Social Welfare (MOHSW) and EngenderHealth in the Iringa Region of Tanzania to improve uptake, retention, and the quality of prevention of mother-to-child transmission (PMTCT) of HIV services. Rather than focusing solely on improving care at one point of service along the PMTCT continuum, our improvement efforts looked at improving PMTCT services across the entire continuum of care, from the antenatal period, through the entire breastfeeding period, until the HIV status of the exposed infant is definitively determined at 11 facilities in Iringa.

In order to address the gaps in PMTCT care that were identified at the 11 facilities, a data system was developed, quality improvement (QI) teams were formed, and facility QI teams began to track indicators for various PMTCT services that should be delivered during antenatal care (ANC), labor and delivery as well as in the post-natal/infant follow-up period.  Providers began testing changes at their respective facilities to address areas in need of improvement.  However, we noticed that some indicators improved (i.e. HIV positive pregnant women started on ARV or ART; and definite testing of the HIV exposed infant), while others lagged behind (i.e. early booking for antenatal care (ANC); male partner involvement; exclusive breastfeeding; and infant and child follow-up visits).  After providers tested several different changes at the facility level and saw little to no improvement in those indicators, it became apparent that improvement efforts would need to go beyond the facility.

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