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Quality, Equity, Dignity: Improving quality of care to achieve ambitious SDG targets
to end preventable maternal, newborn and child deaths
World Health Organization Family, Women’s and Children’s Health Cluster
Conceptual framework to drive the action
READINESS
The Network
Partners: ASSIST, Bill and Melinda Gates Foundation, Council of International Neonatal Nurses (COINN),
Institute for Healthcare Improvement (IHI), International Confederation of Midwives (ICM), International
Council of Nurses (ICN), International Federation of Gynecology and Obstetrics (FIGO), International Pediatric
Association (IPA), Jhpiego, Liverpool School of Tropical Medicine, Management Sciences for Health (MSH), Save
the Children, The Partnership for Maternal, Newborn and Child Health (PMNCH), UNICEF, UNFPA, University
College London, University Research Co., LLC – Center for Human Services (URC-CHS), USAID, WHO
Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Malawi, Nigeria, Uganda, Tanzania
http://qualityofcarenetwork.org/
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What is the Network
A broad-based partnership of committed governments, implementation partners and funding agencies
Country-led and builds on national systems and structures for quality of care and domestic resources
Composed of first wave countries and their partners to build partnerships for learning which can be rapidly drawn upon by other countries
In the context of the drive towards Universal Health Coverage
Every mother, newborn and child receives quality care throughout the pregnancy,
childbirth and postnatal periods
The vision
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Reduce maternal and newborn mortality – reduce maternal and newborn deaths and stillbirths in participating health facilities by 50% over five years
Improve experience of care
Goal and targets
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Strategic Objectives
• LEADERSHIP: Build and strengthen national institutions and mechanisms for
improving quality of care in the health sector
• ACTION: Accelerate and sustain implementation of quality of care
improvements for mothers and newborns
• LEARNING: Facilitate learning, share knowledge and generate evidence on
quality of care
• ACCOUNTABILITY: Develop, strengthen and sustain institutions and
mechanisms for accountability for quality of care
• Quality of care institutionalized in health sector governance, plans and actions at national, district and facility levels
• Effective change packages identified for different contexts and scaled up nation-wide
• Broad-based multi-stakeholder partnership functional in support of the national quality strategy and plans
• Evidence of improvements in care practices and client satisfaction with care leading to reduced mortality and better health outcomes available
• Global network for Quality, Equity and Dignity expanded engaging more countries and more partners and covering the continuum of care for women, children and adolescents
• Knowledge enhanced of effective, scalable and sustainable approaches to improve quality of care
What will success look like
Country Readiness for Quality Programming
Country readiness dashboards (upstream)
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Measure
of success Halving maternal and newborn deaths in health facilities in five years
Strategic
objectives
LEADERSHIP
Country-led, structures,
plans, mobilization
ACTION
Standards and resources,
phased implementation,
institutionalization
LEARNING
Data systems, audit/team
meetings, PLA & PDSA
cycles, global learning
ACCOUNTABILITY
National framework,
institutionalization,
evaluation
Provision of care: Safe & effective
• Evidence-based practices (S1)
• Actionable information system (S2)
• Functional referral system (S3)
• Safety
Experience of care: Person-centred
• Effective communication with patients (S4)
• Respect and dignity (S5)
• Emotional support (S6)
• Continuity of care
Access to care: Equitable & timely
• Timeliness of care
• Provider availability
• Minimized access barriers (cultural, financial,
geographic)
Management and organization
• Competent and motivated staff (S7)
• Supportive supervision
• Population health management
(community)
• Monitoring and continuous quality improvement
• Essential physical resources available (S8)
Outputs /
processes
Outcomes Improved health outcomes Improved care seeking and client
practices Improved user satisfaction
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Inputs Drugs & supplies Workforce Information systems Financing Governance
Existing health system structures
▲ Quality improvement teams (using QoC standards): Through leadership at national, district, and facility levels ▲
Monitoring logic model: Unpacking the links between the strategic objectives and the outcomes of the QoC Network
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Facility • Frontline QI teams
• Learn within facility, community
• 4 components
• Data analysis
• Idea generation
• Implement, Test
• Monitor
District / Regional • Learn across
facilities, communities within a district
• Network learning
National • Learn across
districts for national scale-up
Linking to Learning Agenda
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Data Use
Community Engagement
Quality of Care
Impact, Coverage & Readiness - District
Impact, Coverage & Readiness - National
Impact/ Outcome & Coverage - All levels
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What makes quality “tick”
1. Leadership and governance of quality
2. Adaptive designs for implementation and scale up
3. Financial strategies to support improvement
4. Assessment and provision of resources
5. Engaging women, families, communities in their care
6. Education, training and supportive supervision for clinical and
system activities
7. Data to support improvement
8. Learning communities for accelerating improvement