Effects of global health initiatives on the quality of care for maternal health services in Sub-Saharan Africa: a scoping review protocol.

INTRODUCTION

Global Health Initiatives (GHIs) have significantly improved access to healthcare globally. However, high maternal mortality rates persist in low- and middle-income countries (LMICs) such as Uganda. Despite heavy investment from the GHIs, there is insufficient evidence on the effects of GHIs on the quality of care of maternal health services and yet this significantly impacts maternal outcomes. Available evidence has focused on outputs such as facility deliveries and utilisation of services. These outputs alone are not a reflection of the quality of care, which is crucial in improving maternal outcomes. Given the inadequate information available, we will conduct a scoping review to collate available evidence on the effects of GHIs on the quality of care of maternal health services. The protocol outlined here describes the scoping review aimed at examining the available evidence on the effects of GHIs on maternal health services quality in Sub-Saharan Africa. The information gathered will be used to inform subsequent studies on the effects of GHI on the quality of care of maternal health services in Uganda and later inform policymakers, programmers and health workers on how best to maximise investments from GHIs through improved quality of care. The findings from this study will mainly be used to inform policy on maternal health services in Uganda.

METHODS AND ANALYSIS

The study will use Arksey and O'Malley's enhanced six-stage framework for conducting scoping reviews. The core research question for this review is 'what is the available evidence on the effects of global health initiatives on the quality of healthcare provided for maternal health services in health facilities of Sub-Saharan Africa'. We will consider peer-reviewed and non-peer-reviewed articles, reports and policy documents discussing the effects of GHIs on maternal health services from 2010 to 2023 available in all languages. Relevant databases including Ovid Medline, Embase, Cochrane Library, Centre for Agriculture and Biosciences International Global Health (Ovid), Cumulated Index to Nursing and Allied Health Literature, Scopus and the Joanna Briggs Institute Evidence Synthesis will be used for the search. Grey literature from various sources will also be included. Data on the study design, results and methodology will be extracted using a Google Form. This review's report will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We will employ specific inclusion and exclusion criteria for evidence during the literature screening and mapping process, including study types, focus, timeframe, language and location. The quality of included studies will be assessed using the Critical Appraisal Skills Programme tool and the Mixed Methods Appraisal Tool where applicable. Subsequently, the identified data will be subjected to descriptive analysis and visual representation.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review as it only uses literature available in the public domain. The results will be shared via a peer-reviewed journal, conference presentations and stakeholder consultations.