Continuum of care for maternal, newborn, and child health: from slogan to service delivery

This article from The Lancet revisits the idea of a ‘continuum of care’ for mothers, children and newborns. The term, often used as a slogan, usually refers to continuity of individual care and of places of care. However, the authors point out that there are half a million maternal deaths, four million newborn deaths and six million child deaths each year. They propose a framework for integrated delivery of maternal, newborn and child health (MNCH) services at the population level. This includes eight packages of care used to deliver more than 190 interventions which would be difficult to scale up individually.

The packages include three which are delivered through clinical care (reproductive health, obstetric care, and care of sick newborn babies and children); four through outpatient and outreach services (reproductive health, antenatal and postnatal care, and child health services); and one through integrated family and community care throughout the lifecycle. The paper highlights the problem of low coverage, especially during and after childbirth when mothers and babies are at highest risk. The main barrier to scaling up the packages is poor operational management. Key requirements include: effectiveness trials in various settings, policy support for integration, investment to strengthen health systems, and results-based operational management, especially at the district level.