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 a sequence of services delivered to individuals over time in order to improve individual health outcomes. For healthy motherhood this might start with nutrition and sexual/reproductive health education during adolescence, followed by service provision throughout pregnancy, delivery and the postnatal period and onward to care of infants and young children. Another spatial continuum of care 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.
We unpack and address systemic challenges affecting adolescent reproductive health, family planning, antepartum, intrapartum and postpartum care, early childhood development, and nutrition.
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 with the health system as opportunities to offer services, such as family planning, nutrition or even mental health and psycho-social support during postnatal checks or consultations for child illness. At Mott MacDonald, we understand that successful integration of services depends on a “systems of systems” approach which recognises that contributions to health outcomes are made outside of the health sector. Reaching adolescents, for example, might be best achieved working through schools. Alongside technical expertise in family planning, nutrition and maternal, newborn and child health, we use connected thinking in related sectors such as education, social protection, women’s empowerment, socio-economic development and water sanitation and hygiene. Our multisectoral approach further strengthens the continuum of care by enhancing the integration and quality of services. We further understand that strong health systems are 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. 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.
Supporting community midwives Increasing access to family planning
Antepartum care
Intrapartum care
Gates landscape analysis
Family planning
Our projects
Adolescent health Nutrition
“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.” Lucy Palmer Key account leader for MNCH and 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. Increasing access of girls to SRH services by moving Evidence into Action, 2014-2018 The Evidence for HIV Prevention in Southern Africa Programme (eight research grants managed by Mott MacDonald) made important gains in illustrating how a broad stakeholder engagement process (SEP) throughout the research cycle, could enhance planning of service provision for girls. A combination of generating quality evidence together with targeted research uptake activities led to better debate and in turn better policy and practice design, implementation and outcomes for vulnerable populations in the region. As an example, the research project, Mzantsi Wakho (Your S.Africa) established key areas for inclusion in the 2017 adolescent and youth health policy, highlighting the empirical value of combination interventions for the improvement of health outcomes. At local level the SEP led to changed attitudes of health care workers to adolescents and the expansion of youth friendly spaces. Assessment of MHPSS in humanitarian response, 2022-2023 We were contracted by the Global Child protection Area of Responsibility to conduct an assessment of options for children and adolescents needing specialist mental health services. The purpose was to understand how health, education and child protection sectors could respond flexibly to the dynamic needs of young people at different stages. The assessment included case study explorations in five countries to inform learning and recommendations. We found that familiarity with local terminology and concepts are key to providing culturally sensitive and contextually relevant MHPSS, and that most families started care-seeking outside of the formal health sector, and that schools were seen as an underutilized channel for identifying atrisk cases. We recommended more cross-disciplinary solutions to complex mental health problems.
Technical Resource Facility, Pakistan, (TRF+), 2014-2019 Mott MacDonald provided Technical Assistance (TA) to two provincial governments in Pakistan (Punjab and KP) to strengthen systems for maternal, neonatal and child health. A roadmap approach was developed to improve accountability and implementation of priorities including immunisation and improving availability of 24/7 facility-based safe deliveries. We provided policy support, for example on attracting more community midwives in areas where skilled birth attendance was low, and expanding their scope of work to include mental health and family planning as part of a continuum of care. Management Information systems (MIS) were upgraded to include additional fields on nutrition and maternal health to better link data. Improved data was used to assess district and provincial level performance and as the basis for UK financial aid disbursements. Both provinces showed a large increase in skilled birth attendance, from 53% to 71% in Punjab and from 48% to 67% in KP. Girls Education Challenge, 2020-2024 Mott MacDonald (trading as Cambridge Education) is co-leading (with PWC) the Girls Education Challenge (GEC) - a £855 million global fund which aims to improve the educational opportunities of the world’s most marginalized girls. It includes a vast portfolio of 41 projects, operating across 17 countries. A key focus is social and emotional learning (SEL), providing support over and above learning inputs to help marginalized girls access, engage and thrive in education. Our role is to provide technical and programmatic guidance and support to projects and curate and disseminate learning and evidence around what works. 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. Delivery of patient-centred care requires a combination of behaviour change initiatives and government commitment to sustain transition. Among more promising approaches was an emphasis on developing robust mechanisms for quality management at both facility and district levels. This included reinforcing leadership of district management teams, building their capacity to manage and supervise QI teams, developing robust accountability mechanisms to monitor quality and reliable data and supporting the decision-making process.
South Africa - Better Health Program, 2019-2022 As part of the UK FCDO funded Better Health Programme we developed an innovative peoplecentred learning package known as “Work Integrated Learning” for Community Health Workers which has been integrated into the national training curriculum. The innovative approach was designed in consultation with CHWs and included assessment of their competence to carry out new practical skills such as blood pressure monitoring to shift care along the spatial continuum closer to communities.
Food fortification in Pakistan, 2016-2021 We led the Food Fortification Programme (FFP) in Pakistan, a nationwide programme to fortify all commercially produced wheat flour and oil/ghee. FFP provided 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.
Gavi – Learning and Performance Management, 2020-2021 Mott MacDonald was contracted by Gavi to carry out a global Mapping and Assessment of Innovative Approaches for Health Worker Learning and Performance Management (2020-21). We collated an evidence base of drivers of performance and quality, as well as levers for strengthening performance, including digital interventions. We found that blended and layered approaches are needed, with frontline health workers empowered to use problem-solving approaches to address barriers to service quality and low utilisation.
Opening opportunities with connected thinking. For more information contact a Mott MacDonald expert mottmac.com/contact