Lemma Seblewengel, Daniels-Howell Callie, Tufa Asebe Amenu, Sarker Mithun, Akter Kohenour, Nakidde Catherine, Seruwagi Gloria, Dube Albert, Mwandira Kondwani, Taye Desalegn Bekele, English Mike, Shawar Yusra Ribhi, Mwaba Kasonde, Djellouli Nehla, Colbourn Tim, Marchant Tanya
Department of Disease Control, London School of Hygiene & Tropical Medicine, based in Ethiopia, Addis Ababa, Ethiopia.
Institute for Global Health, University College London, London, United Kingdom.
PLOS Glob Public Health. 2023 Sep 12;3(9):e0001672. doi: 10.1371/journal.pgph.0001672. eCollection 2023.
The Quality of Care Network (QCN) is a global initiative that was established in 2017 under the leadership of WHO in 11 low-and- middle income countries to improve maternal, newborn, and child health. The vision was that the Quality of Care Network would be embedded within member countries and continued beyond the initial implementation period: that the Network would be sustained. This paper investigated the experience of actions taken to sustain QCN in four Network countries (Bangladesh, Ethiopia, Malawi, and Uganda) and reports on lessons learned. Multiple iterative rounds of data collection were conducted through qualitative interviews with global and national stakeholders, and non-participatory observation of health facilities and meetings. A total of 241 interviews, 42 facility and four meeting observations were carried out. We conducted a thematic analysis of all data using a framework approach that defined six critical actions that can be taken to promote sustainability. The analysis revealed that these critical actions were present with varying degrees in each of the four countries. Although vulnerabilities were observed, there was good evidence to support that actions were taken to institutionalize the innovation within the health system, to motivate micro-level actors, plan opportunities for reflection and adaptation from the outset, and to support strong government ownership. Two actions were largely absent and weakened confidence in future sustainability: managing financial uncertainties and fostering community ownership. Evidence from four countries suggested that the QCN model would not be sustained in its original format, largely because of financial vulnerability and insufficient time to embed the innovation at the sub-national level. But especially the efforts made to institutionalize the innovation in existing systems meant that some characteristics of QCN may be carried forward within broader government quality improvement initiatives.
医疗质量网络（QCN）是一项全球倡议，于2017年在世卫组织的领导下，在11个低收入和中等收入国家启动，旨在改善孕产妇、新生儿和儿童健康。其愿景是医疗质量网络能够融入成员国，并在初始实施期之后持续存在：即该网络能够得以维持。本文调查了四个网络国家（孟加拉国、埃塞俄比亚、马拉维和乌干达）为维持QCN所采取行动的经验，并报告了所吸取的教训。通过对全球和国家利益相关者进行定性访谈，以及对卫生设施和会议进行非参与式观察，开展了多轮迭代数据收集。总共进行了241次访谈、42次设施观察和4次会议观察。我们使用一种框架方法对所有数据进行了主题分析，该方法定义了六项可采取的促进可持续性的关键行动。分析表明，这六项关键行动在四个国家中均有不同程度的体现。尽管发现了一些薄弱环节，但有充分证据支持已采取行动将这一创新举措在卫生系统中制度化，激励微观层面的行为主体，从一开始就规划反思和调整的机会，并支持政府的有力主导。有两项行动基本缺失，削弱了对未来可持续性的信心：管理财务不确定性和促进社区参与。来自四个国家的证据表明，QCN模式无法以其原始形式维持下去，主要原因是财务脆弱性以及在国家以下层面嵌入这一创新举措的时间不足。但特别是在现有系统中将创新举措制度化所做的努力意味着QCN的一些特点可能会在更广泛的政府质量改进举措中得以延续。
