Improving the quality of essential health services

Improving the quality of care requires a health systems approach that combines evidence-based service protocols, patient-centred service delivery, use of data to inform decision making and a continued focus on quality and performance management to foster competent and motivated staff. Mott MacDonald therefore approaches effectiveness and quality of care from various angles (organisational, technical, human resource development etc.)

Antimicrobial resistance (AMR) is a major threat to health systems around the world, but LMICs are particularly vulnerable to AMR due to limited access to appropriate antibiotics and to unknown, unreported levels of resistance of specific pathogens. Both of these undermine health service outcomes but most LMICs lack the quantity and quality of data to address the problem. As the Management Agent for the Fleming Fund (2016-2021), we run a £235 million-pound global, regional and country grants programme aimed at strengthening capacity in 24 low and lower middle-income countries to help them address AMR through improved surveillance and reporting.

Other AMR work has been commissioned from us by the EBRD in Georgia (2018 – 2019) and Turkey (2019 – 2020) where we are assessing selected private-public partnership hospitals to help them improve their antibiotic stewardship an infection prevention and control practices, as well as carry out appropriate management of patients with resistant infections. We have also worked with WHO on AMR, exploring options to increase investments in national action plans on antimicrobial resistance in low- and middle-income countries (2017).

In South Africa our Better Health Programme (2019 – 2024), funded by the UK Prosperity Fund, supports the South African government on its journey towards universal health coverage. Improving the quality of treatment and care for noncommunicable diseases (NCDs) is a particular focus: in addition to promoting a multisectoral response, integrating NCD data and surveillance and supporting civil society networks for patient empowerment and engagement, we are also strengthening health technology assessments. Some of the initiatives we support include the development of a systemwide quality improvement strategy, developing a framework for patient engagement on safety and quality, and helping the government scale up certification of both private and public facilities.

The Better Health Programme continues our long-term health systems strengthening involvement in South Africa since 2010. The foundation of this is the strong relationship we built with the National Department of Health (NDoH) when we implemented the UK funded £37 million programme to Strengthen South Africa’s Response to HIV and Health (2010 – 2016). This had two strands, firstly helping NDoH reduce mother-to-child transmission of HIV from 13% to 3% over the course of those six years by increasing acess to early detection and treatment of HIV. Secondly, we helped NDoH to prepare for national health insurance by setting up a quality assurance system for providers, preparing the public primary care system to compete with the private sector and evaluating different purchasing models.

NCDs are also the focus of our Strategic Health Partnership in Samoa (2015 – 2020). Although Samoa has relatively high government expenditure on health in comparison to other small island states in the Pacific, it still has NCDs as its highest cause of death. Funded by the Australian government, we work with the Samoan Ministry of Health and the Australian Queensland Department of Health to share knowledge, skills and experiences and work collaboratively to develop solutions to common issues.

Monitoring, Evaluation and Learning

An important source of learning about strengthening country health systems and moving towards universal coverage is through the rigorous programme and impact evaluations that Mott MacDonald undertakes in a range of countries. The focus of many evaluation contracts has been on assessing the effectiveness and value for money of interventions aimed at reaching the unreached and the most vulnerable.

We are the independent evaluator for the Bill and Melinda Gates Foundation programme, Improving the quality and use of HIV data in Malawi (2015 – 2021). Our role is to generate lessons on how best to introduce new information technology into existing government systems. The intention is to encourage more frequent use of health data in routine decision-making at all levels, whilst understanding how and why decision-making has improved and establishing whether HIV service delivery has improved as a result. In addition, for the same donor, we are undertaking the External Evaluation of the Better Immunization Data Initiative (2014-2019) implemented by PATH in Tanzania and Zambia.

We have just finished Monitoring and Evaluating the Reproductive Maternal & Neonatal Health Innovation Fund for DFID Ethiopia (2014-2019). The fund aimed to improve the health outcomes of women, newborns and young people in the pastoral list regions of Ethiopia. As independent contractors to DFID we monitored the work of a wide range of sub-recipients and evaluated the programme as a whole. In addition, we carried out value for money assessments and provided technical support for operational research.

Elsewhere in Africa we ran the UK funded Evidence for HIV Prevention in Southern Africa (EHPSA) programme (2014-2018), focusing on research around preventing HIV in adolescents, prisoners and LGBTI in South Africa, Malawi, Lesotho, Namibia, Swaziland and Zambia . Not only did this programme generate evidence to identify the most effective and efficient HIV prevention responses, but it also supported strategies to translate that evidence into action. This was important for the design of interventions to help targeted vulnerable populations – adolescents, prisoners and LGBTI – about whom research and programming efforts have been insufficient. Evidence generated by the programme had some notable impacts on policy and practice on HIV prevention in the region. For example, in Kenya, the Anza Mapema study on HIV services for MSM, including the provision of preexposure prophylaxis (PrEP), has informed the approval and implementation of PrEP as part of the national programme.