Local Systems and Service Delivery
MCSP applies a health systems lens to work with national, regional, district and facility managers — as well as frontline health workers — to strengthen essential health system functions, and to continuously improve utilization and quality of maternal and newborn care across the system and life cycle continuums of care. We work with regional and district counterparts to strengthen:
- Management, supervision and capacity-building for health workers;
- Quality, safety and person-centeredness of routine and complications maternal health care;
- Actionable information systems in which priority health care indicators are tracked and used by distinct actors across the system;
- Management of essential commodities such as magnesium sulfate for management of pre-eclampsia;
- Improvements in respectful maternity care and reductions in mistreatment in childbirth; and
- Referral protocols and processes for women and newborns who develop complications that cannot be managed at primary level.
We seek innovative approaches to strengthen referral systems, with linkages to community and civil society organization and, where appropriate, eHealth applications.
The Program works with government counterparts and partners to support facility health worker teams and community health workers to identify and overcome local obstacles to provision of evidence-based respectful care and to regularly calculate and analyze quality of care process and health outcome measures to assess their progress. In collaboration with country government counterparts, we promote regular shared learning across sites to increase health worker engagement, instill confidence of managers and health workers, and to accelerate progress through shared learning about “what works” in a specific context.
We work with country counterparts to prioritize and promote core packages of evidence-based antenatal care, childbirth and postnatal care high-impact “clinical intervention bundles,” and a small number of associated quality of care process and outcome measures. These packages include action-oriented tools and strategies to improve integrated routine best practices needed by every mother and newborn and to improve prevention, early detection, and management of maternal and newborn complications including:
- Postpartum hemorrhage (PPH);
- Pre-eclampsia / eclampsia (PE/E) and hypertensive disorders of pregnancy;
- Maternal/newborn infection;
- Obstructed labor;
- Birth asphyxia; and
- Preterm birth.
For example, MCSP is developing job aids, checklists and other implementation materials to assist providers to adhere to new World Health Organization guidelines into their routine and complication care practices. The Program promotes improved prevention and case management of PPH and PE/E in line with guidelines in the updated WHO Managing Complications in Pregnancy and Childbirth manual.
We assist country counterparts to promote client-centered respectful maternity care and reduction of mistreatment in childbirth, working through local participatory processes that adapt evidence to the local context. MCSP promotes interventions that improve women’s and families’ engagement in and experience of care and strengthen support to health workers.
In addition to our work to strengthen the prevention and management of direct causes of maternal mortality, we also prioritize the prevention and management of indirect causes of maternal mortality including integration of nutrition, newborn, family planning, immunization and infection disease into prevention and treatment in antenatal care, childbirth and postnatal care. Because infections often cause serious intrapartum and postpartum complications for both mothers and babies, we focus attention on the prevention and prompt management of common infections, including bacterial infections, HIV, tuberculosis, malaria, and sexually transmitted infections.