Assessing readiness and results in MNH care

Health systems are complex, and system mapping is an innovative way to break down and understand this complexity. GOAL’s Resilience for Systems (R4S) approach underpins our programme design and implementation, offering a suite of tools to map and collaboratively analyze existing health system status. The mapping tool which, using a range of data collection methods to gather relevant secondary and primary information, aims to enhance the comprehension of systems through visualization of their interactions. This tool facilitates the analysis of healthcare delivery providing a more holistic understanding. The mapping shows the key actors supporting and regulating the system’s core functions. We are using this tool to ensure our deep understanding of the health systems we work with and to design programming for optimal sustained health RMNCH outcomes which are resilient to shocks. We hope to further enhance the approach by leveraging AI to develop dynamic system maps.

In a region with the highest maternal mortality rates in Madagascar, we describe the impact of a health systems strengthening intervention on maternal mortality rates and coverage of maternal and reproductive health interventions.

This mixed-methods study assessed maternal and newborn service readiness in 48 facilities across three northern Nigerian states using the WHO SARA framework. Quantitative data examined staffing, infrastructure, EmONC equipment, and drug availability; qualitative data explored delivery barriers. Of 1,087 Skilled Health Personnel (SHPs), nurse-midwives made up 45%, but distribution was uneven, Bauchi was severely understaffed. WISN analysis showed staffing shortages at both primary and secondary levels in Bauchi state. Facility readiness was weak: none had uninterrupted electricity, only 13% had all essential EmONC equipment, and no facility had written SOPs. Caesarean rates were highest in private hospitals (42%), while assisted vaginal deliveries were rare. Qualitative insights revealed frequent stock-outs, unclear accountability, and reluctance to use available equipment. The findings highlight the need for systemic reforms beyond infrastructure focusing on equitable staffing, written protocols, and stronger institutional support to improve maternal and newborn care and enhance SHP effectiveness.