Fragile Settings

We focus on context-specific needs within countries, including addressing localized differences that impact the health and well-being of communities in fragile settings.

While we have made considerable progress in reducing maternal and child mortality globally, disparities persist. In 2019, the under-five mortality rate in the 36 countries classified as ‘fragile’ based on the World Bank definition was almost three times higher than in ‘non-fragile’ countries.1 Fragile regions or settings are vulnerable to acute shocks like natural disasters, conflict, disease outbreaks, or violence, or more chronic stressors such as political or economic instability. Due to the multidimensional nature of fragility, many sectors and organizations are engaged in fragile settings. Often, development and humanitarian assistance are required simultaneously, especially in complex and recurrent crises.

Regardless of the cause, these factors impact countries’ abilities to deliver and sustain equitable and quality maternal, newborn, and child health services, voluntary family planning, and reproductive health (MNCH/FP/RH) care.

MOMENTUM’s Approach

The MOMENTUM project is a strategic shift in USAID’s approach to technical assistance in fragile and humanitarian settings so that more tailored solutions are offered to meet the health needs of vulnerable women and children and their communities. We also increase the resilience of countries and systems (including public and private health institutions) to better respond to shocks and stressors such as the COVID-19 pandemic, which has affected the delivery of quality health care and, ultimately, maternal, newborn, and child survival.


Tailor technical assistance

Fragile settings require dynamic and customized technical assistance to meet the health needs of their populations, which span from emergency care to longer-term preventive health services. During acute shocks, humanitarian organizations often provide immediate lifesaving health care services. But such support often lacks a clear strategy to adapt these interventions and to longer-term recovery and rebuilding.

MOMENTUM works with local governments to strengthen service delivery in fragile settings, often during the intersection of humanitarian and development assistance programming. With this approach, we bridge the gap between humanitarian and development programming. In a transition setting, for example, the project assists ministries of health to adapt MNCH/FP/RH service delivery approaches and technical guidelines to transition care to the community setting, with increased attention to the responsiveness and equity of care. Because settings are dynamic and can experience varying levels of fragility, our teams monitor changes in status in near real-time and adjust their technical assistance accordingly.

A nurse counsels an HIV-positive patient at a clinic in Mama Lucy Kibaki Hospital in Nairobi.
IMA World Health

Scale up life saving interventions

MOMENTUM works with local governments and health care providers to increase the availability and use of proven, high-impact MNCH/FP/RH interventions and practices. Recognizing that many families may be unable to reach a health facility in high-threat environments, we focus on building individual and family level resilience to minimize these disruptions with the goal of maintaining good health during a crisis.

With her child wrapped in her arms, a mother balances a bag of Super Cereal Plus.
Allison Shelley/Lutheran World Relief
Local leadership

Strengthen local ownership

Fragile settings often include international humanitarian agencies and organizations working quickly to provide emergency health care during a crisis. The transition from humanitarian to development assistance requires country leadership and local participation to be successful.

MOMENTUM uses several approaches to address this challenge:

  • Prioritize strengthening technical capacity for local governments and institutions rather than directly implementing programming.
  • Provide direct funding to local governments and organizations to develop and implement programming within the humanitarian-development nexus,  an overlap of humanitarian and development assistance in fragile and conflict-affected settings, that addresses maternal and child health care needs as areas stabilize.
  • Identify local organizations outside of the health sector that can deliver credible health messages and care, as well as technical support and mentorship.
A group of Indian Women Smiling
Images of Empowerment/Getty

Expand knowledge and practice in fragile and humanitarian settings

We assist ministries of health to adopt evidence-based health care delivery approaches to fragile and humanitarian settings, understanding that each country requires a tailored solution to meet the needs in these environments.  We also develop and implement new state-of-the-art approaches to MNCH/FP/RH care across the humanitarian-to-development nexus, collaborating and sharing learnings among local and international experts and organizations.

Men in DRC look intently at their phones.
IMA World Helath/Corus International


  1. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), “Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation,” United Nations Children’s Fund,
    New York (2020).

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