Pradeep and Soniya Pulame Ale Magar are certified community medicine assistants who run the Road City Healthcare Hospital in Nepal. This couplepartnered with MOMENTUM Private Healthcare Delivery to improve their facility and strengthen their business delivering family planning (FP) services.

Through the partnership, Pradeep and Soniya attended training sessions on adolescent sexual reproductive health (ASRH), provision of a broad range of contraceptive methods, and how to offer high-quality FP services in a respectful and dignified manner, regardless of age or marital status.

During MOMENTUM’s initial assessments, Soniya and Pradeep’s facility failed to meet MOMENTUM’s quality standards for FP, which include quality of counseling, infection prevention, stock of FP commodities, and privacy and confidentiality. With continued supportive supervision by MOMENTUM, since June 2022 the hospital consistently achieved scores between 85 and 100 percent in monthly quality assessments conducted by project staff. “I feel high-quality service is important. If we provide quality services from our hospital to every client, that helps to increase client satisfaction,” Soniya reflects.

The training also helped Pradeep and Soniya prioritize quality ASRH services. “Working with MOMENTUM … we understand how providing respectful services to adolescents and young people can help improve quality of service and help our business grow,” Pradeep said. They are confident that now they have the vision and strategy to grow their business sustainably with both the client and quality of care at the center of their approach: “What I have learned is we have to grow based on quality and client needs,” Soniya explained. Between June 2022 and July 2024, the facility had 5,098 clients visits for short-acting contraceptives, of which 22 percent were adolescents (15 to 19 years) and 31 percent were young people (20 to 29 years).

As of August 2024, MOMENTUM has enhanced the technical capacity of more than 1,000 private providers like Soniya and Pradeep in Nepal and has helped more than 800 private sector health facilities and pharmacies across six provinces improve their business acumen and demand-generation skills, helping to foster sustainable, high-quality health services.

While traditional fistula programs focus on prevention and treatment of the condition, holistic fistula care addresses the range of physical and psychosocial challenges patients may face and considers a patient’s community while developing immediate and long-term follow up plans. In response to findings that many fistula patients also experience gender-based violence (GBV), MOMENTUM Safe Surgery in Family Planning and Obstetrics worked with Nigeria’s National Obstetric Fistula Centers (NOFICs) to integrate GBV services within holistic fistula programming.

In Ebonyi state, GBV cases are identified at NOFICs and referred to the hospital-based One Stop Center (OSC), where women and girls can receive counseling, psychological support, clinical management and treatment, and legal services. Project staff supported OSC staff and the state’s social works department to use GBV screening and documentation tools to identify fistula patients who might have experienced GBV. “With this integration in our facility, fistula patients who experienced GBV are open to us during counseling, and the integration makes it easier to identify their problems and provide them with medical and referral services. Some of our patients were even linked to the legal department for legal intervention to stop future occurrences,” said a social worker from NOFIC Ebonyi.

With MOMENTUM support, 100 percent of project-supported facilities now have an active or recently updated GBV referral list or directory. In less than one year, 183 patients were screened for GBV, 33 of which were referred for GBV services.

MOMENTUM strengthened surgical and non-surgical fistula treatment services, conducted community outreach to raise awareness about fistula among more than 1.3 million people, and improved data systems to track patients for continued engagement with health services over time.

For many expectant mothers in Malawi, missing an antenatal care (ANC) visit means waiting another month for the next appointment. This was the case for Efrida Mwale during her first pregnancy three years ago. The long distance to the Linyagwa Health Center made it difficult for her to reach the facility on specific days, leading to missed ANC appointments and missed interventions like preventive malaria treatment (intermittent preventive treatment for pregnant women—IPTp).

Recognizing these challenges, the MOMENTUM Tikweze Umoyo project collaborated with health facility staff to increase ANC attendance and uptake of IPTp. ANC services were made available throughout the week, increasing accessibility for expectant mothers.

This simple change has made Linyagwa Health Center, where over 37,000 individuals receive primary health care services, including maternal care, more responsive to patient needs. The flexibility has made it easier for husbands to accompany their wives to ANC visits, increasing male involvement during pregnancy. The clinic has seen ANC visits increase by 23 percent and a surge in IPTp uptake from 26 percent in December 2023 to 52 percent in June 2024.

Gertrude Magomero, a nurse at Linyagwa Health Centre, said, “We have noted positive changes. We now attend to over 20 pregnant women daily. Pregnant clients start ANC immediately upon confirmation [of pregnancy], instead of [us] telling them to come on a designated day.”

Efrida, now pregnant with her second child, appreciates the changes that make the routine and preventive care she needs more accessible. “It’s nice knowing that I can come to the hospital any time I am not feeling well instead of waiting for my ANC appointment date,” she said. “I have already received two doses of IPTp, and I am scheduled for the third dose next month.” Her story is a reminder of the power of innovation and collaboration in breaking down barriers to health care access and expanding patient-centered care.

Partnering with local organizations, which often have broad reach, can increase access to health care for people who may otherwise be missed. This is the case with SALFA (the Malagasy Lutheran Health Department), which runs 50 health centers across Madagascar, including 26 rural health clinics in remote areas, serving nearly 100,000 people.

MOMENTUM Country and Global Leadership worked with SALFA to counsel young, first-time parents on sexual and reproductive health (SRH). Together, MOMENTUM and SALFA adapted, pre-tested, revised, and implemented a counseling approach tailored to young, first-time parents in the region. Using this approach, community health agents from the Ministry of Health mobilized by SALFA in the Antsirabe I district reached almost 1,300 couples with information about SRH, helping them understand how family planning (FP) can help them achieve their goals and aspirations. Eighty-nine percent of those who were referred for SRH services accessed the services, including 335 new family planning users.

MOMENTUM’s partnership with SALFA included strengthening their organizational capacity through training in adaptive management, updating their procedures and procedure manual, and developing a resource mobilization strategy. “[The partnership] has improved SALFA’s capacity and organizational performance and has improved our visibility to carry out community-based action plans for sexual and reproductive health through public-private partnerships,” said SALFA’s Voahangy Ratsiorivololona.

These skills helped SALFA secure new funding to expand their SRH programming. With funding from Global Health Ministries to support their Community Health Nurses project, SALFA has trained 17 out of 26 rural health clinics spread throughout Madagascar to strengthen the quality of their FP and SRH counseling during facility visits.

Achieving locally led, sustainable development requires supporting and providing resources to local actors most familiar with their communities. That is why MOMENTUM Private Healthcare Delivery partnered with Total Family Health Organization (TFHO), a leading Ghanaian organization, to strengthen TFHO’s capacity while expanding outreach for family planning (FP).

To increase provision of long-acting and reversible contraceptives in private sector facilities, TFHO developed a blended learning strategy for providers to complete some portions of training remotely and at their own pace. This program trained 200 providers who reached more than 5,900 clients with FP services or counseling.

In addition, MOMENTUM supported TFHO to strengthen their own capacity. As Isaac Ndaya, a director at TFHO, said, “When I speak about capacity building, I speak about the fact that it has to do not just [with] individuals, but even the structures of the organization, the resources.… So the critical thing is sustainability.…Sustainability is a guiding principle of every activity we do.”

TFHO identified Methodist Health Service Ghana’s (MHSG) network of private sector facilities and co-created an approach to strengthen their service delivery for FP and reproductive health (FP/RH). As Isaac described their collaborative relationship: “We sat with [MHSG] together.… They are also a local organization, so it is more peer-to-peer than coming from the top and then pushing down knowledge.”

Isaac further explained, “We needed to train [MHSG] on comprehensive FP, particularly on long-acting reversible contraception, using new models such as Counseling for Choice, which we call C4C—counseling with emotional intelligence and person-centered care.”

With increased capacity and an expanded service delivery network through MHSG, TFHO was positioned to carry on their support for MHSG and FP/RH service delivery as the primary award on a new, five-year bilateral USAID project focusing on building private sector partnerships to advance FP and maternal and child health.

In Niger, MOMENTUM Integrated Health Resilience is strengthening high-quality, voluntary family planning (FP) services and health resilience among communities in the Dosso and Tahoua regions. MOMENTUM identified the Initiative for Resilience, Research and Development in the Sahel (I2RD-Sahel) as a leading local organization that could help carry out this work and expand uptake of voluntary postpartum FP.

Postpartum FP is a critical intervention, as Attefine Ladjil, executive secretary for I2RD-Sahel, explained: “Postpartum FP offers mothers who have just given birth the opportunity to adopt a contraceptive method immediately, before leaving the health center. By spacing births, women can rest between their pregnancies, take care of themselves, and breastfeed their child for at least 18 months.”

MOMENTUM trained 15 I2RD-Sahel staff who then replicated the training for field agents and community health workers. These partners conduct regular discussions in communities, organize small group sessions, and carry out home visits to strengthen uptake of postpartum FP.

In 18 months of implementation, I2RD-Sahel has carried out 10,816 home visits by 52 local community health workers to provide information about FP, reaching 75,712 people (36,342 men and 39,370 women). “Since we started this work,” Attefine explained, “we’ve noticed that women are using postpartum FP services more and more, compared to before the partnership with MOMENTUM. Several of the health centers we work with have confirmed this, and the increases also show up in national data.”

MOMENTUM also supported I2RD-Sahel’s efforts to strengthen their organizational capacity. I2RD-Sahel used strategies developed through the partnership to apply for funding, securing support from USAID and the United Nations for two new projects.

“As an organization, we’ll be moving forward, consolidating and building on what we’ve already learned from and achieved with MOMENTUM support,” Attefine said. “We are now confident and ready to face the future.”

With almost three decades of experience as a midwife, Masri Ndoen now focuses on delivering high-quality primary health care as the new leader of the Batakte Community Health System in the West Kupang subdistrict of Indonesia. In this role, she oversees primary health care services for around 20,000 people.

Masri spends her days making sure the 54 community-based health posts and outreach centers that are part of the Batakte Community Health System provide high-quality health services to all who need them. When she stepped into this role 18 months ago, Masri received feedback from her team that they needed more support. She also recognized gaps in health worker performance and a lack of data. “We needed to assess ourselves and make improvements,” she said.

With help from MOMENTUM Country and Global Leadership, which provides facilitative supervision, feedback, assistance, and training, Masri has begun implementing changes. “With facilitative supervision, the health workers built their skills back up,” said Masri. “Now they take the initiative to conduct routine emergency drills every two weeks and we review data and performance every morning.”

“Ultimately, our goal is to create a healthy community,” Masri explained. “But we can’t achieve that without actively involving the people we serve. There need to be efforts made by and through the community itself so we can all reach our shared goal.”

Protracted conflict and political unrest in Yemen have resulted in economic collapse, the displacement of millions of people, and limited access to primary and essential health care services. In response, MOMENTUM Integrated Health Resilience is strengthening the capacity of health providers and the overall health system.

Approximately 4 million women in Yemen lack access to maternal and reproductive health care services, and 2.4 million children under five are at high poverty levels and malnourished. Given these realities, midwives can play a vital role delivering primary health care. Midwife Suaad Hussien Al-Haj works at Ibn Khaldoun Hospital, the largest hospital in Yemen’s Lahj Governorate and also operates her own home-based clinic. On average, 30 mothers and children from nearby villages visit Suaad’s clinic each month.

To strengthen her skills beyond midwifery, Suaad participated in a six-day infant and young child feeding (IYCF) training for health care providers carried out by MOMENTUM and Yemen’s Ministry of Public Health and Population. Through the training, Suaad learned about optimal feeding practices to ensure that children ages 0 to 23 months have healthy growth, development, and well-being.

“The training provided me with excellent knowledge,” Suaad said. “I was able to counsel the mothers about breastfeeding and complementary feeding, and I responded to their questions and concerns. I had to take into account their simple lifestyle and the use of cheap and available food.” The IYCF course was one of several MOMENTUM nutrition-focused capacity strengthening sessions that reached more than 300 primary health care providers in Yemen between November 2023 and March 2024.

For people living in Ndhiwa, a subcounty of Homa Bay in Western Kenya, malaria is a pervasive threat. The subcounty has one of the highest malaria rates in the country, with nearly 60 percent of children under age five contracting malaria each year. The new malaria vaccine has the power to change those statistics—but only if immunization programs can effectively deliver and complete the four-dose vaccine schedule for children at risk.

In 2023, MOMENTUM Routine Immunization Transformation and Equity began working with global partners and Kenya’s National Vaccines and Immunization Program to distribute the new vaccine in Kenya. Health worker Judith Odero already sees an impact: “In previous years, we used to admit approximately 15 children per month with severe malaria and treat many more with non-severe malaria. With the [malaria] vaccine, we have seen reduced malaria admissions as well as less malaria-related anemia and deaths in our hospital. Our under-fives are thriving.”

Expanding routine immunization programs by adding the malaria vaccine creates an additional touchpoint to identify and deliver the primary health care that promotes good health. As Judith explained, “If we get a two-year old child coming in for the fourth dose of the malaria vaccine, we check if the child has received the second dose of the measles-rubella vaccine. We also check to see if there are other vaccines that may have been missed.” Judith uses these visits to identify and respond to client needs, talking to them about the importance of routine immunization, the need to complete all the vaccines in the schedule, and good health practices in the home.

As part of the malaria vaccine roll-out, MOMENTUM trained community health promoters to counsel caregivers about the four-dose vaccine series. MOMENTUM continues to support health promoters to track children who haven’t yet completed the vaccine schedule and monitor for adverse events.

Strengthening capacity for locally led organizations is key to ensuring that development work puts local actors in the lead, strengthens local systems, and is responsive to local communities. With these goals in mind, MOMENTUM Knowledge Accelerator developed PERFORM, an innovative tool to evaluate an organization’s capacity, identify needed performance improvement, and guide course corrections in a timely manner. The focus of this tool, unlike many others, is on an organization’s performance rather than latent capacity.

PERFORM builds upon other capacity assessment tools to address the gaps or limitations they may have. In addition to the focus on performance, PERFORM is unique in how it guides local users to apply data gathered through mapping and reviews of iterative performance plans to generate learning insights and strengthen understanding of how to improve performance. Using PERFORM, locally led organizations can set goals for their organizational capacity and performance and then lead the process to grow toward those goals.

Following the tool’s launch in 2024, MOMENTUM is using PERFORM to increase the capacity of partner institutions and local organizations to deliver high-quality, evidence-based maternal, newborn, and child health services; voluntary family planning; and reproductive health care. CIS Timor was one of the first organizations to use PERFORM—and with positive results. As the organization’s director, Harris Oematan, said, “We are delighted because PERFORM has expanded our thinking and imagination far beyond what it was before. We have already created concept notes [for our goals] and we have communicated with donors who have agreed to fund us for six months of humanitarian response work in eastern Indonesia. PERFORM is high level, it pushes us to think big.”

In Tanzania, MOMENTUM Integrated Health Resilience focuses on population, health, environment interventions, with a strong family planning (FP) component. During a routine progress meeting, the team reviewed client and financial data and found that, although existing FP events attracted many clients, they were costly and offered only short-term FP options to clients, rather than a full range of FP methods.

In response, the team started organizing monthly events at remote local facilities during which visiting specialists from higher-level facilities offer long-acting and permanent FP methods to clients. Community health workers and community leaders helped communicate the changes locally to ensure clients were aware of the services. The pivot brought an expanded range of care options to new and returning clients.

Delivering FP services through skilled providers who have time to offer comprehensive counseling, respond to clients’ questions, and provide a full range of methods is making a difference in service uptake. Prior to the change, most FP clients chose short-term methods (62 percent) compared to long-acting and reversible contraceptives—LARCS, (38 percent). After the change, the share using short-term methods (51 percent) and LARCS (49 percent) was nearly the same, with a three-fold increase in the number of clients who opted for permanent FP methods. The number of FP clients overall increased by 53 percent and the couple-years of protection generated at these health facilities increased by 84 percent. Regular and comparative data review, cost-benefit analysis, and a focus on quality of care helped the program adapt to its context and achieve better outcomes for clients.

In Addis Ababa, a national measles vaccination campaign for children was integrated with other primary health care services, including routine immunization, deworming, screening for malnutrition, and treatment for common ailments. MOMENTUM Routine Immunization Transformation and Equity hoped to leverage this vaccination campaign to reach the caregivers of children to provide COVID-19 information and vaccination.

As the campaign rolled out at temporary access points across communities, one community within Addis was significantly underperforming in its COVID-19 vaccination goals. During MOMENTUM-led supportive supervision, with the teams running community access points, data revealed that many caregivers were leaving the service site without learning about the COVID-19 vaccine. Restructuring the patient flow in the facility to address this gap more than doubled average daily COVID-19 vaccinations at the site, from 351 to 841.

This change was made during the first few days of the campaign, which led to more successful rollout of services and more people being protected against COVID-19. The adaptation was then scaled across all service sites, expanding the learning model and increasing the chances of the campaign’s overall success. Early detection was possible because of daily data collection and analysis and supportive supervision practices. During the vaccination campaign, the MOMENTUM-supported facilities administered 16,560 COVID-19 vaccine doses.