Individual, organizational and system circumstances, and the functioning of a multi-country implementation-focused network for maternal, newborn and child health: Bangladesh, Ethiopia, Malawi, and Uganda

Abstract

Better policies, investments, and programs are needed to improve the integration and quality of maternal, newborn, and child health services. Previously, partnerships and collaborations that involved multiple countries with a unified aim have been observed to yield positive results. Since 2017, the WHO and partners have hosted the Quality of Care Network [QCN], a multi-country implementation network focused on improving maternal, neonatal, and child health care. In this paper, we examine the functionality of QCN in different contexts. We focus on implementation circumstances and contexts in four network countries: Bangladesh, Ethiopia, Malawi, and Uganda. In each country, the study was conducted over several consecutive rounds between 2019–2022, employing 227 key informant interviews with major stakeholders and members of the network countries, and 42 facility observations. The collected data were coded using Nvivo-12 software and categorized thematically. The study showed that individual, organizational and system-level circumstances all played an important role in shaping implementation success in network countries, but that these levels were inter-linked. Systems that enabled leadership, motivated and trained staff, and created a positive culture of data use were critical for policy-making including addressing financing issues—to the day-to-day practice improvement at the front line. Some characteristics of QCN actively supported this, for example, shared learning forums for continuous learning, a focus on data and tracking progress, and emphasising the importance of coordinated efforts towards a common goal. However, inadequate system financing and capacity also hampered network functioning, especially in the face of external shocks.

Effectiveness of a multi-country implementation-focused network on quality of care: Delivery of interventions and processes for improved maternal, newborn and child health outcomes

“…The QCN is a highly complex network in its composition, functioning and activities, operating at all levels of governance. In other papers from this collection, we analysed the complexity of the network’s composition and functioning at global, national, sub-national and local levels [ 7 , 10 , 19 – 21 ]. In this paper, our analysis focuses on the effectiveness of the QCN through its various outputs and policy consequences as well as through the impact of such activities.…”

“…The COVID-19 pandemic further contributed to weakening partners’ support to activities in learning sites [ 21 ]. Issues around resources dedicated to QCN are taking place in a context of weak health system capacity, in terms of material and human resources, undermining network effectiveness in all countries.…”

Do Networks facilitate innovation, learning and sharing? An evaluation of the Quality-of-Care Network (QCN) in Bangladesh, Ethiopia, Malawi, and Uganda

“…Further, there has not been a substantive number of innovations reported across the network countries. Whilst the network has created systems and contributed to improved circumstances for learning, innovation and sharing for quality improvement, further improvements and investments in individual and organizational capacities are required to effect greater changes [18]. Implementation has also often followed a MNCH holistic approach to quality improvement, not necessarily specific to the network itself.…”

“…This analysis was part of a broader multi-country evaluation of QCN [15-18], common methods are reported in our methods supplement for our QCN evaluation collection of papers (S2 Text). Key aspects of the methods in relation to this paper are summarized below.…”

“…At the national level, a QCN Coordination Team was established in 2019. Its operations were coordinated by the Ministry of Health's Quality Management Directorate (QMD) with a dedicated officer responsible for stakeholder coordination [18]. With funding from partners such as WHO, UNICEF, GIZ and USAID, regular meetings were held by this committee, among others to review and develop strategic documents and brainstorm quality improvement implementation progress and provide strategic planning and technical support to the network.…”