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Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO’s Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework’s cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework’s provision and experience of care dimensions would fill significant data gaps in LMICs.

IntroductionDiverse gender and geographical representation matters in research. We aimed to review medical and global health journals’ sex/gender reporting, and the gender and geography of authorship.Methods542 research and non-research articles from 14 selected journals were reviewed using a retrospective survey design. Paper screening and systematic data extraction was conducted with descriptive statistics and regression analyses calculated from the coded data. Outcome measures were journal characteristics, the extent to which published articles met sex/gender reporting guidelines, plus author gender and location of their affiliated institution.ResultsFive of the fourteen journals explicitly encourage sex/gender analysis in their author instructions, but this did not lead to increased sex/gender reporting beyond the gender of study participants (OR=3.69; p=0.000 (CI 1.79 to 7.60)). Just over half of research articles presented some level of sex/gender analysis, while 40% mentioned sex/gender in their discussion. Articles with women first and last authors were 2.4 times more likely to discuss sex/gender than articles with men in those positions (p=0.035 (CI 1.062 to 5.348)). First and last authors from high-income countries (HICs) were 19 times as prevalent as authors from low-income countries; and women from low-income and middle-income countries were at a disadvantage in terms of the impact factor of the journals they published in.ConclusionGlobal health and medical research fails to consistently apply a sex/gender lens and remains largely the preserve of authors in HIC. Collaborative partnerships and funding support are needed to promote gender-sensitive research and dismantle historical power dynamics in authorship.

IntroductionMeasuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for ‘quality’ for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care.MethodsWe created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores.ResultsOur results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification.ConclusionsAs improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.