Over the past 25 years, child and maternal mortality rates have decreased by more than half. Yet, every year, 6.6 million children and nearly 300,000 mothers die from causes that could be prevented. Although innovative reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions are helping to reduce preventable maternal and child deaths, sustained improvements to RMNCAH cannot be achieved through individual intervention alone. Investments in RMNCAH can only be sustained if they are integrated into country health systems, alongside efforts to address the weaknesses within health systems that constrain performance.
Despite the challenge of reducing preventable maternal and child mortality, there are opportunities to propose holistic solutions for stronger health systems to support the delivery and scale-up of RMNCAH interventions. These systems strengthening efforts must focus on addressing barriers that directly limit effective service delivery and supporting the institutionalization and scale-up of innovative RMNCAH interventions.
As a leader working to end preventable maternal and child death globally, USAID’s Maternal and Child Survival Program (MCSP) works to strengthen health systems to improve RMNCAH outcomes. MCSP introduces and supports high-impact health interventions in 24 priority countries with the ultimate goal of ending preventable maternal and child deaths within a generation. The program engages governments, policymakers, private sector leaders, and communities in adopting and accelerating proven approaches to address the major causes of maternal, newborn and child mortality, and improve the quality of health services from household to hospital.
As a MCSP partner, R4D leads the health systems strengthening(HSS) and equity team which encompasses activities at global level and with country programs. R4D’s approach to health systems strengthening analyzes ways to holistically address system-level barriers to provide high-quality RMNCAH. By supporting local changes agents on these systems-strengthening efforts, countries can achieve sustainable improvements to equity, coverage, quality, and efficiency of RMNCAH services.
R4D works in collaboration with MCSP partners that support the delivery and scale-up of RMNCAH interventions, and specifically focuses on:
- improving sub-national management systems and capacity;
- incorporating financial planning and analysis into sustainability planning, and
- monitoring and improving the design of identified pro-equity interventions targeting the poor.
Key R4D accomplishments include:
Rapid Health Systems Assessment: R4D developed this qualitative exercise to quickly diagnose operations and management challenges at sub-national levels, prioritize areas for strengthening, and identify system-level resources available to address challenges. The assessment provides recommendations to enhance the effectiveness and sustainability of planned and ongoing RMNCAH activities. The assessment has been conducted in Nigeria, Rwanda, Guinea, and Mozambique.
Comprehensive Approach to Health Systems Management: R4D developed this process to guide subnational managers to leverage, mobilize, and coordinate local health system resources to increase coverage, utilization, quality, equity, and sustainability of services. The Comprehensive Approach brings together subnational stakeholders to break out of vertical silos and take a holistic view to improve health outcomes; it has been implemented in Tanzania and Guinea.
Financial analysis for scale-up and sustainability planning: R4D supports MCSP country programs to analyze the financial implications of scaling-up high-impact interventions. R4D has led costing work on newborn and family planning interventions in Rwanda to inform national scale-up planning, community-based primary care in Ghana by creating an interactive planning tool for administrators, and costing the strengthening of child health services in Uganda.
Equity analysis to target underserved populations: R4D explores innovative ways to measure equity through household surveys and geographic information systems (GIS) data to help health-sector planners better reach underserved populations. R4D also conducted a global analysis of current state of coverage disparities in MCSP-supported countries and created an interactive dashboard to inform country programming.
Through these approaches, R4D’s MCSP HSS and equity work strengthens critical areas of the health system to support the delivery of high-impact and pro-equity RMNCAH interventions. Please see below more information on specific country programs: