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.

Jake Lyell/IMA World Health

We focus on context-specific health needs within countries, including addressing the unique needs 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’ by the World Bank was almost three times higher than in “non-fragile” countries.1 Fragile settings are vulnerable to acute shocks like natural disasters, conflict, and disease outbreaks, as well as recurrent and chronic stresses such as seasonal environmental effects, food insecurity, and political and economic instability. Due to the nature of fragility, development and humanitarian assistance are often required simultaneously. Whether experienced separately or simultaneously, these factors can affect 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

MOMENTUM is a strategic shift in USAID’s approach to technical assistance in fragile settings, offering tailored solutions to meet the health needs of women and children in vulnerable situations. MOMENTUM works to strengthen the resilience of health systems, communities, and families to better respond to shocks and stresses, such as the COVID-19 pandemic, which has disrupted the delivery of quality health care and, ultimately, maternal, newborn, and child survival.


Building Stronger

MOMENTUM works to strengthen local health provider capacity and to improve the quality of MNCH/FP/RH care. We provide support to clinics and community health care workers (CHWs) by:

  • Mentoring and training health care providers and CHWs.
  • Developing job aids adapted for fragile settings.
  • Supporting health officials to provide supportive supervision.
  • Linking communities with health facilities to increase demand for quality services, and to make health service providers accountable to the communities they serve.
A nurse counsels an HIV-positive patient at a clinic in Mama Lucy Kibaki Hospital in Nairobi.
IMA World Health

Ensuring Continuity of Care

MOMENTUM works to increase the availability and use of quality MNCH/FP/RH care and improve health practices. However, in fragile settings, health services may be disrupted or limited, and some people may be unable to reach health services. We focus on building individual, household, community, and health system resilience to minimize these disruptions to maintain good health during a crisis or times of stress.

Matt Hackworth/IMA World Health

Expanding Reach to Communities in Need

MOMENTUM’s targeted focus on provider training, quality of care improvements, and client-centered services, as well as work with specific local groups and organizations, aims to reduce health-related risks and improve individual and collective agency, behaviors, skills, knowledge, and resources. Furthermore, MOMENTUM works to increase the trust of individuals and communities with their health services by strengthening the quality of respectful health care, including during periods of crisis and stress.

Adrienne Surprenant/IMA World Health

Bridging the Humanitarian Assistance to Development Gap

Fragile settings often include international humanitarian organizations that respond to crises and provide longer-term recovery support. MOMENTUM also works in these settings from the development assistance side to help build resilience and strengthen local capacity for improved MNCH/FP/RH care. MOMENTUM works in the nexus of humanitarian and development efforts, with the goal to transition the situation from humanitarian assistance to development activities. However, circumstances in fragile settings are dynamic and may fluctuate between humanitarian and development needs. Therefore, our teams monitor changes in status in near real-time and adjust their technical assistance accordingly. The movement toward development requires local participation and country leadership to be successful.

Sean Hawkey/IMA World Health
Local Leadership

Expanding Knowledge and Practice in Fragile Settings

Fragile settings require flexible and customized technical assistance to meet the health needs of their populations, which span emergency care to sustained health services. Immediately following acute shocks, humanitarian organizations often provide lifesaving health care, but such support may lack a clear strategy for longer-term recovery and rebuilding.

MOMENTUM uses several approaches to address this challenge:

  • Prioritize strengthening technical capacity for local governments and institutions rather than directly implementing programming.
  • Assist local governments with strengthening health systems for MNCH/FP/RH care.
  • Strengthen local ministries of health and organizations to improve their health management information systems and to use system data to improve MNCH/FP/RH care.

By assisting ministries of health in adopting context-specific and evidence-based health care delivery to fragile settings, MOMENTUM supports partner countries to ensure appropriate and effective health services. We also continue to develop and implement state-of-the-art approaches to MNCH/FP/RH care across the humanitarian-development nexus, collaborating and sharing learning among local and international experts and organizations.

Allan Gichigi/MCSP


  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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