Abstract:
Over the last few years, the South African (SA) National Department of Health has led the design, implementation and monitoring of key
strategies to improve maternal, newborn, and child health outcomes. The strategies have resulted in the reduction of maternal, under-5 and
infant mortality rates in SA. Here, we examine the strategies using a framework to understand the determinants and actions that influence
the quality of care, coverage and resultant programme effectiveness in saving the lives of mothers and children. Three case studies from the
field, namely, the Essential Steps In Managing Obstetric Emergencies, undernutrition in young children and breastfeeding are illustrated
through applying the framework and demonstrating how improved quality of care and coverage achieved better health outcomes for
pregnant women and children under 5 years of age. These case studies highlight different aspects of the framework, including improving
healthcare workers’ skills, ensuring implementation of standard protocols and strengthening management accountability within facilities
and across the districts. We also highlight how these aspects collectively improved the overall programme impact. The paper concludes that
the framework would be strengthened through addition of critical cross-cutting aspects related to targeting and sustainability of actions.
