Strengthening Health Systems to achieve Universal Health Coverage

Increasing coverage for all populations

We have learnt that achieving Universal Health Coverage in most LMICs and fragile states must go hand in hand with reaching the unreached and most vulnerable citizens. This is essential as these population groups are often hard to define, locate or access, but may also benefit least from the interventions and financial safety nets which are aimed at them. We have many examples and success stories about reaching these population groups, not just through vertical interventions but by introducing innovations to existing health systems and social protection programmes.

Mott MacDonald is committed to the global effort to shift Universal Health Coverage into a higher gear. We have more than 25 years on the front line of strengthening health systems in low- and middle-income countries. This gives us the edge in achieving effective, sustainable and far reaching change in resource poor and complex environments. We work closely with national and local governments, health practitioners, development partners and civil society, helping them to reach more people with good quality health services and move towards universal health coverage.

Our health systems approach means we address all the components of the system - from policy, planning, organisational structure and management systems to human resource performance, information systems and quality management at the service delivery level. Our practical approach to technical assistance is grounded in evidence of what works for a particular place and why. Learning from implementation and innovation is built into all our programmes, supplemented by our extensive experience in monitoring and evaluation.

In our experience, working on the supply side is not enough to achieve Universal Health Coverage and financial protection. In many of our projects we work closely with community groups to develop locally meaningful solutions through demand side interventions that foster improved health seeking behaviour. We encourage national health policies and programmes that are country owned, aligned with nationally defined health priorities and sustainable. We also promote responsiveness and accountability of health policies, programmes and services to the populations that they are expected to serve.

Moreover, Mott MacDonald also provides technical assistance in the related sectors of nutrition, education, women’s empowerment, social protection, socio-economic development, water, sanitation and hygiene, and waste management. This gives us a holistic view of health development issues and enables us to mobilise additional specialist inputs.

We specialise in:

Design Helping countries and development agencies design and shape health systems.

Delivery Supporting the delivery of health policies and programmes through long- and short-term technical assistance, capacity building and fund management.

Evaluation Promoting the critical assessment of what works and why, ensuing programmes are grounded in robust evidence.

Country ownership We understand how to respect and foster country ownership, working in close collaboration with Ministries of Health and other partners.

In Somalia we act on behalf of the UK government as the Fund Manager for SHINE, the Supply Component of the Somalia Health and Nutrition Programme (2018 – 2021). Somalia is a hugely complicated, fragile environment, which continues to be severely conflict affected. Our efforts to improve service coverage involve contracting NGOs to deliver an essential health package and simultaneously working with the Somali health authorities to strengthen their capacity to coordinate, manage and plan those services.

People suffering from neglected tropical diseases by definition tend to have particularly poor access to appropriate services. Our Ascend programme (2019 – 2022), funded by the UK government, focuses on those aspects of health systems in West and Central Africa that are essential for widespread sustainable control and elimination of NTDs. Support is tailored to each of the 13 countries according to their priority areas, but commonly focuses on prevention, detection, treatment and surveillance to reduce current disease burden and prevent disease resurgence. In addition, for those countries with the capacity to do so, one of our key strategies is to help them integrate NTD programmes within their domestic health systems.

Ascend is the successor to the UK aid-funded KalaCORE programme for control and elimination of Visceral Leishmaniasis (VL) (2012-2018) which we operated in Ethiopia, Sudan, South Sudan, Bangladesh, India and Nepal. In order to increase service coverage, we helped countries design programmes and establish VL treatment centres that targeted 128 million people. Our focus was on service delivery, vector control, access to effective treatment and piloting of innovative approaches. The programme completion review confirmed that it had successfully contributed to reducing the economic and health impact of VL in South Asia and East Africa. Two key metrics - duration of illness and time between onset of symptoms and getting treatment - were reduced in all countries in Asia and across genders. Case fatality rate regional targets were achieved, and Bangladesh and Nepal met the elimination of VL as a public health problem target.

In Pakistan, we ran a Technical Resource Facility (TRF+) with the governments of Punjab and Khyber Pakhtunkhwa (KP) (2014-2019), supported by UK funding. We focused on outcomes around RMNCH, working with the provincial governments to agree priorities, set targets, build capacity and improve public financial management (PFM). In addition to technical assistance, the use of performance monitoring ‘roadmaps’ helped both governments drive innovative and evidence-based solutions. Both provinces saw a significant increase in skilled birth attendance over the programme period from 53% to 71% in Punjab and from 48% to 67% in KP. This was achieved through intensive monitoring of key inputs e.g. availability of 24/7 specialist staff, plus PFM support to reduce budgetary bottlenecks to ensure timely flow of funds through the system. TRF+ was the successor to our first successful Technical Resource Facility Programme (2009 – 2015).

Under-nutrition affects a large number of Pakistani women and children, undermining progress in social and economic development. On behalf of the UK government we manage the £41 million Food Fortification Programme (2016-2021) widening efforts to reach more children and women of childbearing age with fortified food. We work with federal, provincial and local governments to develop, monitor and enforce food fortification regulations and standards. This is done in close partnership with the commercial food production sector – we work with them to build their capacity to carry out fortification in their factories and to develop their understanding and commitment to playing a role in the national fortification effort. To date, FFP has signed MOUs with 70% of the 1,100 flour mills and is working to address various market failures affecting wheat flour fortification rates. FFP also works with nearly all the 116 active oil/ghee refining mills, who are now successfully fortifying over 90% of their production.

In South Africa our efforts to widen service coverage for all populations have involved working beyond the health sector. As part of a consortium we delivered the USAID funded Government Capacity Building and Support (GCBS) programme (2013-2018) to enable the Department of Social Development to effectively target orphans, vulnerable children and youth affected by HIV. Our other extensive HIV work in South Africa informed our management of the UNAIDS’ Technical Support Facility for Eastern and Southern Africa (2005 – 2017) in which we provided quality technical support and capacity development services to strengthen the delivery of effective national AIDS programmes in 22 countries.