Measuring the impact of the network for improving quality of care for maternal, newborn, and child health

Background: The network for improving quality of care for maternal, newborn and child health was established as a partnership of United Nations agencies, implementing partners, and governments in two South East Asian and eight African countries. The methodology that assessed the impact of the network over a five-year period, the results from impact analysis based on selected indicators and the challenges and limitations in collecting and interpreting such data are presented. Methods: The impact analysis was based on three indicators (institutional maternal mortality rate, pre-discharge neonatal mortality, and obstetric case fatality rate) and seven countries. We obtained Relative Risks (RR) and 95% confidence intervals (CI) from Generalized Estimating Equations Negative Binomial models to evaluate the impact of the network initiative on these indicators, unadjusted and adjusted for available facility characteristics. Results: Most participating facilities were government-managed primary care sites offering antenatal and postnatal care, with prior quality improvement practices. Key factors linked to improved indicators included facility level, geographic location, infrastructure, and partner support. The average rates of institutional stillbirth decreased from the baseline to the intervention period for Ethiopia, Nigeria, and United Republic of Tanzania and increased in Malawi, Sierra Leone and Uganda. Average pre-discharge neonatal mortality rate between the two periods decreased for Ethiopia, Malawi, Sierra Leone, and United Republic of Tanzania but increased for Ghana and Uganda. Average obstetric case fatality rates decreased for Sierra Leone and increased for Ethiopia and Malawi. Conclusions: Our analysis showed whether the indicators changed over time and to what extent but did not confirm the impact of specific interventions. Quality improvement interventions varied across facilities and between countries

Child health · Environmental health · Family medicine · Health care · Health services · Maternal health · MEDLINE · Political science · Population · Global Health and Surgery · Global Maternal and Child Health · Health Policy Implementation Science · Medicine

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