While in many health systems there is an aspiration to provide both continuum and continuity of care with the aim of quality improvement, it is rarely possible to fully implement this given the resource-constrained nature of the health sector in many countries.
The continuum of care has been promoted by many as a critical element in improving the quality of Maternal and Newborn Health (MNH) and was featured in the Lancet Neonatal Survival Series 2 (2005) and the Women Deliver Special Edition (2007). The continuum of care is a ‘core organising principle for health systems that emphasises seamless linkages between health care packages across time and through various service delivery strategies’. It also underpins Partnership for Maternal, Newborn and Child Health (PMNCH) conceptual framework and the Opportunities for Africa’s Newborns publication (2006).
The continuum of care: the dimension of place
Figure 2.5, from the PMNCH framework, shows the linkages between the various places where MNH care is provided. Failing to have an integrated approach to the services and care provided across this range can lead to fragmented services, lowered uptake of services, a loss of efficiency, increased costs and have an impact on the quality of care provided. It can also lead to frustrations for service users and service providers and remove opportunities to promote the uptake of other related services such as post natal care and contraception.
The continuum of care is a “core organising principle for health systems that emphasises seamless linkages between health care packages across time and through various service delivery strategies”.
The continuum of care: the dimension of time
The factor of time is important to consider from a quality perspective. Childbirth and the immediate few days after delivery are considered the most risky times for the mother and baby. Two-thirds of maternal deaths occur in the postpartum period (see Li et al 1996) and 30% of stillbirths during childbirth (see Kerber et al 2007).
Although improving the quality of services during high risk times are a priority, MNH services cover a broad timespan from pre-conception to after delivery for both mother and newborn. The concept of the continuum of care encourages consideration of the access to quality MNH services throughout this lifespan.
Figure 2.6 outlines how an effective continuum of care will address the needs of mothers, the newborn and child throughout the life cycle, wherever care is provided namely: at home, primary care, district and regional or provincial levels.
- Kerber, K.J., de Graft-Johnson, J.E., Bhutta, Z., Okong, P., Starrs, A. and Lawn, J.E., (2007) Continuum of care for maternal, newborn, and child health: from slogan to service delivery
- World Health Organization (WHO), Partnership for Maternal, Newborn and Child Health (PMNCH), (2011) PMNCH Fact Sheet: RMNCH Continuum of care
- Li, X.F., Fortney, J.A., Kotelchuck, M. and Glover, L.H. , (1996) The postpartum period: the key to maternal mortality
- National Institute for Health and Care Excellence (NICE), (Website) Quality statement 11: Continuity of care
- Tinker, A. Hoope-Bender, P t. Azfar, S. Bustreo, F. Bell, R., (2005) A continuum of care to save newborn lives
- The Lancet, (2007) Women Deliver
- The Partnership for Maternal, Newborn and Child Health (PMNCH), (2006) Opportunities for Africa’s newborns: Practical data, policy and programmatic support for newborn care in Africa