Opportunities to sustain a multi-country quality of care network: Lessons on the actions of four countries Bangladesh, Ethiopia, Malawi, and Uganda.

Autor:	Lemma S; Department of Disease Control, London School of Hygiene & Tropical Medicine, based in Ethiopia, Addis Ababa, Ethiopia., Daniels-Howell C; Institute for Global Health, University College London, London, United Kingdom., Tufa AA; Health System Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia., Sarker M; Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh., Akter K; Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh., Nakidde C; School of Public Health, Makerere University, Kampala, Uganda., Seruwagi G; School of Public Health, Makerere University, Kampala, Uganda., Dube A; Parent and Child Health Initiative PACHI, Lilongwe, Malawi., Mwandira K; Parent and Child Health Initiative PACHI, Lilongwe, Malawi., Taye DB; Ministry of Health, Health Service Quality Directorate, Addis Ababa, Ethiopia., English M; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom., Shawar YR; Bloomberg School of Public Health and Paul H. Nitze School of Advanced International Studies, John Hopkins University, Baltimore, Maryland, United States of America., Mwaba K; Institute for Global Health, University College London, London, United Kingdom., Djellouli N; Institute for Global Health, University College London, London, United Kingdom., Colbourn T; Institute for Global Health, University College London, London, United Kingdom., Marchant T; Department of Disease Control, London School of Hygiene & Tropical Medicine, based in Ethiopia, Addis Ababa, Ethiopia.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Sep 12; Vol. 3 (9), pp. e0001672. Date of Electronic Publication: 2023 Sep 12 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0001672
Abstrakt:	The Quality of Care Network (QCN) is a global initiative that was established in 2017 under the leadership of WHO in 11 low-and- middle income countries to improve maternal, newborn, and child health. The vision was that the Quality of Care Network would be embedded within member countries and continued beyond the initial implementation period: that the Network would be sustained. This paper investigated the experience of actions taken to sustain QCN in four Network countries (Bangladesh, Ethiopia, Malawi, and Uganda) and reports on lessons learned. Multiple iterative rounds of data collection were conducted through qualitative interviews with global and national stakeholders, and non-participatory observation of health facilities and meetings. A total of 241 interviews, 42 facility and four meeting observations were carried out. We conducted a thematic analysis of all data using a framework approach that defined six critical actions that can be taken to promote sustainability. The analysis revealed that these critical actions were present with varying degrees in each of the four countries. Although vulnerabilities were observed, there was good evidence to support that actions were taken to institutionalize the innovation within the health system, to motivate micro-level actors, plan opportunities for reflection and adaptation from the outset, and to support strong government ownership. Two actions were largely absent and weakened confidence in future sustainability: managing financial uncertainties and fostering community ownership. Evidence from four countries suggested that the QCN model would not be sustained in its original format, largely because of financial vulnerability and insufficient time to embed the innovation at the sub-national level. But especially the efforts made to institutionalize the innovation in existing systems meant that some characteristics of QCN may be carried forward within broader government quality improvement initiatives. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Lemma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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