Continuum of care

What is the Continuum of Care?

The "Continuum of Care" for maternal, newborn and child health includes integrated service delivery for mothers and children from pregnancy to delivery, the immediate postnatal period, and childhood. Such care is provided by families and communities, through outpatient services, clinics and other health facilities.

The Continuum of Care recognizes that safe childbirth is critical to the health of both the woman and the newborn child—and that a healthy start in life is an essential step towards a sound childhood and a productive life.

What are the dimensions and importance of the Continuum of Care?

The first dimension of the Continuum of Care is time - from pre-pregnancy, through pregnancy, childbirth, and the early days and years of life (Figure 1. Connecting care giving across the Continuum for maternal, newborn and child health).

The second dimension of the Continuum of Care is place - linking the various levels of home, community, and health facilities (Figure 2. Connecting care giving between households and health facilities to reduce maternal, newborn, and child deaths).

Linking interventions in this way is important because it can reduce costs by allowing greater efficiency, increase uptake and provide opportunities for promoting related healthcare elements (e.g. postpartum/postnatal and newborn care).

How much would implementing the Continuum of Care cost?

It is estimated that an additional US $ 10.2 billion per year over the next ten years is needed to reach all children and three quarters of all mothers and babies in the 75 worst affected countries with the priority and full range of interventions effective during pregnancy, childbirth and postpartum. ¹

Providing basic maternal care costs about $3 per person per year in low-income countries.²

A package of 20 affordable interventions including skilled care at birth, emergency obstetric care, breastfeeding, vaccinations, antibiotics, vitamins could save 6 million children per year at a cost of only $25 per child or $1.62 per person in 60 priority countries.³

Where are the current gaps in the Continuum of Care?

The chart below based on findings from Tracking Progress in Maternal, Newborn and Child Survival- Countdown to 2015 - The 2008 Report ⁴ shows average care coverage during key periods: pre-pregnancy, pregnancy, childbirth, the postnatal period and childhood. The bars show the highs and lows of care - a rollercoaster of ups and downs as opposed to the consistent high coverage needed to reduce mortality. The thin black bars represent the huge variations between countries.

The chart below, from the Lancet Countdown to 2015 Issue⁵, highlights three priority coverage gaps across the "Continuum of care".

Family planning services: Only one third of women in the 68 priority countries are using a modern contraceptive method.

Skilled care during childbirth and the postnatal period: Only around half of women benefit from a skilled birth attendant at the time of birth, though this is the riskiest period for mother and infant. Care during the critical postnatal period is even lower, an important missing link in the continuum of care.

Clinical care for sick children: Only about one-third of children with pneumonia – the biggest single killer of children – receive the right treatment.

¹The Global Call to Leaders and Other Donors .
²The Inter-Agency Group for Safe Motherhood.
³Lawn, J. "for the Price Tag for Newborn and Child Survival." Presentation at Child Survival Countdown to 2015, December 2005.
⁴Countdown to 2015 website
⁵Tracking progress in Maternal, Newborn and Child Survival: Countdown to 2015- The 2008 Report
⁶The Lancet: The Countdown to 2015 Issue - April 2008