National learning systems to sustain and scale up delivery of quality healthcare: a conceptual framework

Abstract

All around the world, health systems fail to provide good quality of care (QoC). By developing learning systems, health systems are able to better identify good practices and to explain how to sustain and scale these good practices. To facilitate the operationalisation of national learning systems, the Network for Improving Quality of Care for Maternal Newborn and Child Health (the Network) developed a conceptual framework for national learning systems to support QoC at scale. The Network facilitated an iterative process to reach consensus on a conceptual framework for national learning systems to sustain and scale up delivery of quality healthcare. Following a landscape analysis, the Network Secretariat and WHO convened two consultative meetings with country partners, technical experts and stakeholders. Based on these inputs, we developed a conceptual framework for national learning systems to support QoC at scale. National learning systems use a variety of approaches to identify practices that have improved QoC at the patient and provider levels. They also facilitate scale up and sustain strategies used successfully to support quality improvement. Despite growing consensus on the importance of learning for QoC, no one has yet detailed how this learning should be operationalised nationally. Our conceptual framework is the first to facilitate the operationalisation of national learning systems so that health systems can begin to develop, adapt and implement mechanisms to learn about what works or fails and to scale up and sustain this learning for QoC.

Optimization of Care Pathways Through Technological, Clinical, Organizational and Social Innovations: A Qualitative Study

“…With a view to future spread and scaling, the various points raised in our study do not contradict the literature; thus it seems essential to anticipate spread and scaling up, 40 both on the part of the decision-makers and the research team, insofar as methodological skills and knowledge must be shared 46,47 and disseminated in order to allow for scaling up. 47 The limitations of our findings lie in the fact that they are based on a single case study and only consider the perspective of the willing participants.…”

Delivering quality care to all mothers and newborns requires governments to engage the private sector

“…However, even if motivated, the ability of governments to engage the private sector in delivering quality care depends on the existence or implementation of regulatory and financing mechanisms that facilitate collaboration and partnership, as well as expertise to engage the private sector 1019. Multi-stakeholder policy dialogues on private sector engagement to deliver quality of care for maternal and newborn health conducted in Ghana (2020) and Nigeria (2021) emphasised the need for more structured engagement with government through the development of financial mechanisms, such as tax rebates, loans, or guarantees to support private providers’ ability to deliver quality care 20. The Global Financing Facility has also invested in multiple financing tools and instruments such as blended financing, impact bonds, and capital market instruments to enable countries to engage the private providers in a more structured way in delivering quality maternal and newborn health services.…”

“…While investing in the public health system to deliver quality care and achieve universal health coverage should be a priority for all governments, it is also important to recognise that in mixed health systems, healthcare is not delivered by the public sector alone 10. All providers across public and private sectors have a role in improving quality of maternal and newborn healthcare, and given the private sector also provides an increasing market share of maternal and newborn health services in many low and middle income countries, this further reinforces the need for a structured engagement of the private sector 20…”

How has Guinea learnt from the response to outbreaks? A learning health system analysis

“…Referring to Garvin’s definition of a learning organisation,7 a learning health system (LHS) can be defined as a health system skilled at creating, acquiring, interpreting, transferring and retaining knowledge, and at purposefully modifying its behaviour to reflect new knowledge and insights. Over the past decade, there has been a growing interest in LHS 8–22. An LHS builds on the recognition that health systems are complex, adaptive and social institutions that dynamically respond and adapt to changing needs and contexts, and it also potentially has a long-term orientation towards change and transformation that goes beyond resilience 20.…”