Enhancing Maternal and Newborn Care for Better Outcomes

Tanzania continues to face high maternal mortality at 104 deaths per 100,000 live births, driven by unresponsive maternal and newborn health (MNH) services and weak accountability. Limited community influence further undermines service quality and trust. To address these gaps, Americares and the Christian Social Services Commission implemented the USAID-funded Respectful Maternal Care (RMC) project in Mwanza, adapting and implementing the Community Scorecard (CSC), a participatory tool that brings communities, providers, and local authorities together to assess and improve MNH service quality and uptake.
From June 2023 to September 2024, the CSC engaged nearly 3,000 participants across 30 villages in five councils through 60 events. Participants included women of reproductive age, male partners, youth, healthcare providers, community leaders, Health Facility Governing Committees (HFGCs), council officials, and national stakeholders. HFGCs received targeted training to embed accountability within routine governance. Using a structured evaluation matrix aligned with draft national guidelines, participants assessed provider behavior, client reception, accessibility, affordability, and service quality, and co-developed action plans.
Women reporting access to mechanisms to address mistreatment increased from 25% to 75%, and 80% of facilities implemented actions improving provider attitudes, punctuality, and communication. MNH service utilization rose, with 4+ antenatal visits up 32% and institutional deliveries by 9%. Sites combining CSCs with provider training achieved greater gains, highlighting the added value of linking social accountability with complementary interventions.
The CSC adaptation for RMC demonstrates that community-led action engaging providers, communities, and government strengthens system responsiveness and fosters adaptive, inclusive mechanisms that improve maternal and neonatal outcomes.  

In the western state of Rajasthan, India, community-driven interventions focusing on maternal and child health outcomes successfully strengthened participation, trust, and accountability of service delivery platforms. Under the guidance of the National Health Mission and with support from partners like IPE Global, Children's Investment Fund Foundation and Ekjut, Rajasthan implemented these interventions using  Participatory Learning and Action (PLA) to empower the local governance platform of Village, Health, Sanitation, Nutrition, Committees (VHSNCs). 
PLA is a proven method for empowering communities to assess their realities, address challenges, and collaborate for solutions. Backed by Lancet research and endorsed by the government of India, Rajasthan adopted the 24-meeting PLA-led VHSNC model in five tribal districts of Rajasthan, 2021-22. Empowering the local actors with data, decision-making authority, and supportive supervision, this PLA-led VHSNC model was able to drive context-driven changes-be it improving diet diversity, ensuring timely antenatal checkups and supplementation, or improving uptake and purpose of social protection schemes. 
Launched initially in five tribal districts and later expanded to five more, the model has revitalised VHSNC governance, increased participation, and improved maternal and child nutrition outcomes. Through structured PLA meetings, training of Accredited Social Health Activists, and rigorous monitoring, the initiative has delivered impressive results: better antenatal care registrations, improved maternal and child dietary diversity, higher compliance with maternal benefit schemes, improved immunisation rates, and better compliance to breastfeeding and complementary feeding practices, confirming that when systems are responsive, they improve outcomes, coverage, and trust in public institutions. 

Maternal health in Ethiopia continues to be a challenge, particularly in rural areas where many births occur at home and antenatal care (ANC) attendance remains low. To address these challenges, this study employed a Human-Centered Design (HCD) approach to co-create behavioral interventions that encourage health facility-delivery and ANC visits. Implemented in two woredas in Oromia region, the design process engaged 204 participants-including underserved pregnant women, their husbands, healthcare providers, and community influencers-across two iterative workshop rounds. Participants collaboratively developed empathy-driven tools such as stakeholder maps, personas, and journey maps, which guided the formulation of "How Might We (HMW)…" statements that framed core maternal health challenges. From this ideation process, four low-fidelity prototypes emerged, of which a self-paced audio-based couples' dialogue prototype, supported by visual print materials, was selected in two rounds of validation and user testing, and resulting high acceptability, usability and feasibility scores. The prototypes scaled into interventions aimed to foster joint decision-making around ANC and institutional delivery by facilitating private, culturally tailored conversations between couples. Community-based volunteers played a key role in delivering the interventions and guiding households, ensuring both relevance and reach. The interventions led to a notable 12 percentage point increase in health facility delivery and a doubling of ANC attendance in the intervention group. These findings highlight the potential of HCD as a strategic tool for designing scalable, user-driven health interventions to increase maternal health service use among vulnerable populations.

Empathy and compassion are critical to client experience of care (EoC) and provider well-being, yet postpartum care has received limited attention. In Tanzania, Breakthrough ACTION collaborated with the Ministry of Health and the USAID-funded Uzazi Staha project to co-design and pilot a compassion-focused, multi-component intervention. Through human-centered design, providers, supervisors, community members, and health officials developed a package including compassionate leadership training, mentorship, self-care practices, client feedback tools, compassion champions, provider self-assessment, and client charters. 
The intervention was implemented for six months across three intervention and three comparison facilities (dispensaries, health centers, hospitals). A baseline and endline survey assessed outcomes among providers and clients. 
Findings showed significant improvements among providers in skills (supportive communication, kindness, perspective-taking), resilience, enthusiasm for work, and reduced burnout (p < 0.05). Providers also reported greater organizational support, including facility care for their well-being, availability of help, and recognition of their contributions. At the endline, 92% wished to continue the intervention. 
For clients (n=360), experiences of care improved significantly across all ten measured components-sensitivity, compassion, respect, trust, involvement in decisions, and quality of communication-compared to no change in comparison facilities. 
This pilot demonstrates that compassion-focused interventions can simultaneously improve client EoC and provider well-being, offering a scalable approach to strengthen respectful, human-centered health systems.