Quality improvement in maternal and newborn healthcare: lessons from programmes supported by the German development organisation in Africa and Asia

Abstract

Improving the quality of maternal and child healthcare (MCH) is a mandatory step on the path to reaching the Sustainable Development Goals and Universal Health Coverage. Quality improvement (QI) in MCH is a strong focus of the bilateral development cooperation provided by Germany to help strengthen the health systems of countries with high maternal and child mortality rates and/or with high unmet needs for family planning. In this article, we report on the findings of an analysis commissioned by a community of practice on MCH, of Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). The objectives were to review the QI interventions implemented through programmes which have received technical assistance from GIZ on behalf of the German Federal Ministry for Economic Cooperation and Development in 14 Asian and African countries, to identify and describe the existing approaches and their results, and finally to draw lessons learnt from their implementation. Our analysis of the information contained in programme documents and reports identified five main methodologies used to improve the quality of care: capacity-building and supervision, governance and regulation, systemic QI at facility level, support to infrastructures, and community support. It is difficult to attribute the observed progresses in maternal and neonatal health to a particular agency, programme or intervention. We acknowledge that systemic implementation research embedded within the programmes would facilitate an understanding of the determinants of successful QI interventions, would better assess their effectiveness, and therefore better guide future bilateral aid programmatic decisions.

Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya

“…Facility-based QI has been shown in many locations in the region to yield positive effects in maternal and newborn healthcare outcomes, like those evaluated here. 69–72 However, rates of early presentation and diagnosis/treatment without community involvement remain persistently low due to cultural reasons, poor access and costs. 73–75 The converse is also true: without good facility-level care and treatment, community-level QI does not yield health impact and communities lose trust in community health workers that referred them.…”

Scoping review protocol of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries

“… 4 The sustainable development goals seek to expand the gains of reduced maternal and child mortality, achieved during the MDG era by 2030, 1 through better quality of care coupled with expansion of health service coverage under the banner of universal health coverage. 5 …”

“… 11 12 There are three common service delivery-related approaches for improving maternal and newborn health: quality improvement (QI), health system strengthening (HSS) and implementation science (IS). 5 13 …”

Care for Neonates in Haiti’s Health System – Outcomes and Lessons

“…In addition to improving skilled care at birth, we need to generate evidence of the impact of providing skilled care to neonates requiring hospitalization in lowresource settings. Case management in neonatal care units can inform quality concerns for neonatal morbidity, mortality, and survival [16]. Rural hospitals in Haiti often lack the capacity to care for newborns after birth due to gaps in essential infrastructure, equipment, supplies, medicines, trained staff, and up to date protocols and guidelines [15].…”