READ: Introduction to the Continuum of Care (CoC)
The global trend in child mortality shows that fewer children die than ever before: the number of under-five deaths has been steadily declining since the 1990s. Although this is a fantastic development, neonatal mortality – the death of a baby within the first 28 days of its live – has declined a lot slower.
West Africa, where this Health and Nutrition workshop takes place, has the highest maternal, neonatal and child mortality rates in the world. Each year, at least 1.16 million African babies die in the first 28 days of life – and 850,000 of these babies do not live past the week they are born.
The four most common causes of death after this period are pneumonia, diarrhoea, malaria and undernutrition, but the majority of deaths caused by pneumonia and diarrhoea take place within the first two weeks of life.
Maternal mortality, or death caused by complications from pregnancy or childbirth, is also still a big issue in some regions. Although global maternal mortality declined by 38% between 2000 and 2017, in most sub-Saharan African countries the maternal mortality rate is still high, very high or extremely high.
In the past, the needs of newborn babies and mothers were often addressed separately by healthcare policies. But the healthcare needs of mothers, new-born babies and children are “inseparably linked”, and approaching these needs individually has led to gaps in care. The Continuum of Care (CoC) is therefore concerned with reaching mothers and babies at the crucial time and place. It focuses on joint efforts of improving the health of mothers, newborn babies and children throughout all the different stages in their lives.
The CoC consists of two important dimensions: place and time. Its approach to place connects the different levels of health care spaces, consisting of households, communities and health facilities. In most African countries, maternal and newborn deaths usually happen at home, often because the poorest households cannot reach critical care in time. Long distances to health facilities, poor quality of these facilities and financial difficulties all relate to ‘place’ and contribute to bad health and the risk of death. By linking care in these different spaces – the home, the health centre and the hospital – the CoC aims to improve effective caregiving.
The second main facet is time. The CoC links caregiving across the different times in the life of mother and child. Maternal and neonatal health ranges from adolescence or pre-pregnancy of the mother, to pregnancy, to childbirth, postnatal, and infancy of the child. It is important to connect caregiving efforts of these different stages, because the effect in each period depends on the quality of care in the previous period. For example, good care during pregnancy makes a safe birth more likely, and good care during the delivery and right after childbirth boosts the chances of survival for both mother and baby.
In short, the Continuum of Care takes an integrated approach towards community care and clinical care, as well as towards care during the different stages of pregnancy, childbirth and postpartum/postnatal. According to CoC, supporting the health of newborn babies and their mothers does not require new, separate efforts, but instead should aim for the integration and strengthening of the existing services and care packages to make them more efficient.
The remainder of the workshop in the week ahead will include sessions on particular aspects of the Continuum of Care: adolescents, women health and nutrition, children under six months, and integrated child health. Stay tuned to the Nutrition and Health Workshop portal and share your thoughts and comments below!
Follow the discussion live at Action Against Hunger’s International Learning Community on Facebook and Action Contre la Faim West and Central Africa on Facebook and Twitter.
The Partnership for Maternal, Newborn & Child Health (PMNCH), Opportunities for Africa’s Newborns, WHO on behalf of The Partnership for Maternal Newborn and Child Health, 2006.
World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 1990 to 2015, 2000 to 2017, WHO, Geneva, 2015-2019.