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