PMNCH operational principles
The Partnership continues to promote the Continuum of Care
The Continuum of Care concept is now agreed to be the best approach to improving women’s and children’s health. It encompasses effective intervention packages for RMNCH – the period from pre- pregnancy to a child’s ﬁfth birthday – which are provided either by families and communities or health facilities. The Continuum of Care concept helps to focus attention on the effective delivery of health services, addressing gaps in service provision and highlighting the needs for human and ﬁnancial resources. It is also both contingent on, and a catalyst for, a well-functioning health system.
The Continuum of Care has: (i) a life-cycle dimension; and (ii) a place-of-care dimension. The key points to note about these are:
- Life-cycle dimension. The relevant life-cycle is assumed to start before pregnancy and, in the context of the reproductive and sexual health of women, to extend through pregnancy, birth and on to the baby’s childhood and the health of its mother. The stages of the life-cycle are naturally interdependent. Reproductive health will impact on pregnancy, and the health of a pregnant woman will impact on the health of the newborn child. As such, interventions throughout the life-cycle need to be linked and mutually supportive. For example, where relevant, antenatal care should promote PMTCT,27 skilled attendance at delivery and keeping mothers alive, which in turn should be linked to postnatal care for both mother and newborn. By providing the context for deﬁning integrated packages of care and how they should be delivered, the Continuum of Care can be an effective framework for improving the quality of service delivery.
- Place-of-care dimension. Aspects of where and how care is provided are similarly interdependent. Household education will help to prevent health complications, quality care in communities will reduce the need for hospitalization, and sound primary-care referral systems will support better treatment for acute conditions. Essential interventions addressing the problems affecting women and children therefore need to take place at all levels of the health system, i.e. from the home to the community and through to the hospital. This dimension of the Continuum of Care recognizes the importance of the health system as a whole. It also acknowledges that a well-functioning health system includes components such as health workforce, health-service delivery, health-information systems, medical products, vaccines and technologies, health ﬁnancing, health leadership and governance. In other words, when services identiﬁed through the Continuum of Care are put in place, the health system will be strengthened.
These two dimensions of the Continuum of Care provide a “space” in which evidence-based essential interventions can be deﬁned and implemented in high-burden countries, as illustrated in Figure 1 below.
In this space, for example, there will exist interventions that are aimed at addressing the pre-pregnancy stage in the life-cycle, but which could be provided in household, community and hospital settings. In the same manner, there are community-based interventions that span the whole life-cycle dimension. The key beneﬁt of using this Continuum of Care approach is that it enables the Partners to deﬁne and implement interventions so that they are mutually supportive across the two different dimensions, and that any gaps (e.g. no interventions for dealing with birth in a household setting) are identiﬁed and dealt with – such as those identiﬁed in Figure 2 below.