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.

Survive & Thrive Final Report

Demonstrated that training is not enough and that quality improvement approaches are essential to sustain quality care for mothers and newborns in low-resource settings, the Survive & Thrive Final Report highlights the efforts that partners shared through developing tools and resources.

A breakthrough contribution of the Global Development Alliances (GDA) was its development of a practical approach to engage frontline health workers in improving quality of maternal and newborn care.  The GDA’s Improving Care of Mothers and Babies guide, developed by the USAID ASSIST Project and the American Academy of Pediatrics, breaks down the process of improvement in clear steps that providers can follow to plan, test, implement, continuously assess, and sustain process changes to deliver care in the best way possible for the setting. The guide, which has been translated to French and Spanish, is a critical resource to ensure care is optimized once providers have been trained.   

An equally important component of the GDA was to ensure that quality improvement (QI) is part of the implementation and long-term sustainability of maternal and newborn care. The Improving Care of Mothers and Babies: A guide for improvement teams, includes information and tools to facilitate implementation of quality improvement activities at the facility level.  The Guide outlines the process of improvement step-by-step, helping providers plan, test, implement, continuously assess and sustain interventions that enable care to be delivered in the best way possible.  Improving Care of Mothers and Babies can guide those new to improvement methodologies, as well as provide further support to those who have experience implementing and managing improvement projects.  It can be used by a leader or facilitator to help others learn about improvement in both clinical and workshop settings and can also be used as a self-study manual by improvement teams and individuals.

Download Survive & Thrive Final Report

Dando respuesta a los asuntos de género para mejorar los resultados en la atención en salud relacionada con el Zika

Este documento proporciona información sobre los problemas relacionados con el género en relación con la atención médica relacionada con el Zika.

Resalta los principales problemas:

• Roles y valores relacionados con el género
• Acceso limitado y / o control sobre educación sexual, anticonceptivos y otros servicios de salud reproductiva
• La falta de poder de las mujeres para negociar el uso de anticonceptivos (incluidos los condones)
• Estigma que lleva al abandono de la madre y el niño

Version en español

Responding to Gender Issues to Improve Outcomes in Zika-related Health Care

This document provides information on the issues surrounding gender with regards to Zika- related health care.

It highlights the main issues:

• Gender-related roles and values
• Limited access to and/or control over sexuality education, contraceptives, and other reproductive health services
• Women’s lack of power to negotiate contraceptive use (including condoms)
• Stigma leading to mother and child abandonment

English Version

 

Privacy, a companion of choice and swift referrals; the key to improve mothers' experience of care

Since March 2017, the Ministry of Health in Uganda, in collaboration with USAID ASSIST Project has been working to improve the experience of care for mothers delivering their babies in health facilities. The focus was on 15 health facilities in the two districts of Gulu and Nwoya in Northern Uganda. Through exit-interviews with mothers who had delivered both in the hospital and at home, health facilities were able to identify areas to specifially improve the experience of care.

Mary Atim Ladwong, a midwife in Anaka hospital, and Lilly Grace Ayamo, a clinical officer in Koch Goma Health Centre IV, share what steps they took to improve experience of care, and how it affected their work.

Listen here

Improving postpartum care in a large hospital in New Delhi, India

Despite recent progress, the maternal mortality ratio (MMR) in India remains high at 174 per 100 000 live births. Bhagwan Mahavir Hospital (BMH) is a secondary level hospital in New Delhi. In 2013, five women died in BMH’s postpartum ward. In January 2014, a United States Agency for International Development-funded team met with BMH staff to help improve their system for providing postpartum care to prevent maternal deaths. The hospital staff formed a quality improvement (QI) team and, between January and December 2014, collected data, conducted root cause analyses to understand why postpartum women were dying and tested and adapted small-scale changes using plan-do-study-act cycles to delivery safer postpartum care. Changes included reorganising the ward to reduce the time it took nurses to assess women and educating women and their relatives about common danger signs. The changes led to an increase in the number of women who were identified with complications from two out of 1667 deliveries (0.12%) between January and May 2014 to 74 out of 3336 deliveries (2.2%) between July and December 2014. There were no deaths on the postpartum ward in 2014 compared with five deaths in 2013 but the reduction was not sustained after the hospital started accepting sick patients from other hospitals in 2015. QI approaches can improve the efficiency of care and contribute to improved outcomes. Additional strategies are required to sustain improvements.

Improving postpartum care in a large hospital in New Delhi, India

Reducing preventable maternal, newborn, and child deaths at scale by improving care effectiveness and efficiency

Online

Wednesday, July 25th, 9:00-10:00 a.m. ET (Washington, D.C.)

USAID estimates that we could save the lives of more than 15,000 children and 830 women each day just by reliably delivering evidence-based care, every time, to the people who need it. Sounds simple in theory, but what does this look like in practice?

Evaluation of a Results-based Financing Intervention in South West Uganda

Results-based financing (RBF) usually refers to a form of funding that provides financial payment incentives to staff or service units for achieving specified levels of performance. The Uganda Ministry of Health (MoH) developed a national results-based financing (RBF) framework with the goal of promoting efficient delivery of and access to quality, cost-effective services.

To learn how RBF might improve care in Uganda, an intervention was developed by the USAID Regional Health Integration to Enhance Services in South West Uganda (RHITES-SW) Project, supported by Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), which combined the following three interventions at eight health centers:

  1. Providing supplies
  2. Supporting staff through monthly supervisory visits and coaching to improve quality
  3. Offering incentives to achieve measured indicators of quality of care

ASSIST was asked by USAID and EGPAF to evaluate the interventions. The objectives of the evaluation were to:

  • Inform the Ugandan Ministry of Health’s RBF roll-out strategy.
  • Increase knowledge on effectively implementing RBF activities to improve quality of care in a USAID priority country for preventing child and maternal deaths, including identifying appropriate incentivized indicators that can be incorporated into an RBF mechanism and lead providers to undertake quality improvement strategies.
  • Build on the Global Financing Facility’s work to inform the global learning agenda for RBF and quality of care.

The interventions were planned to be implemented by RHITES-SW between January and July 2017. ASSIST independently evaluated the intervention over the same period. The evaluation combined both qualitative and quantitative methods to assess the intervention’s effect.

Read the full report to learn more.

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