Leadership, action, learning and accountability to deliver quality care for women, newborns and children

The Member States of the World Health Organization (WHO) are committed to achieve quality, equity and dignity for women, newborns and children as reflected in the four World Health Assembly Resolutions.1–4 These resolutions provide the foundation to reach the targets for maternal, newborn and child health and survival5 of the sustainable development goal on health, and universal health coverage. Although coverage of health services has increased, many women, newborns and children continue to die from poor care practices, even after reaching a health facility.6,7 Poor care practices are not limited to the medical aspects of care or resources needed to provide this care; research has demonstrated a disrespectful or neglectful treatment in the facilities that negatively impacts the care outcomes for women and newborns.8 Implementing an approach to improve quality of care at scale that is effective and sustainable is critical to further reduce mortality and improve health outcomes.9 Recognizing the need for action, the national governments of Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Malawi, Nigeria, Uganda and United Republic of Tanzania, together with WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), implementation partners and other stakeholders, have established the Network for Improving Quality of Care for Maternal Newborn and Child Health care.10 The network has agreed to pursue the ambitious goals of halving maternal and newborn deaths and stillbirths and improving experience of care in participating health facilities within five years of implementation. Under the leadership of the participating countries’ health ministries, the network will support the implementation of national frameworks for quality improvement by pursuing four strategic objectives: (i) leadership by building and strengthening national institutions and processes for improving quality of care; (ii) action by accelerating and sustaining implementation of quality-of-care improvement packages through operationalizing a standards-based approach to quality improvement; (iii) learning by promoting joint learning and generating evidence on quality planning, improvement and control of health services; and (iv) accountability by developing, strengthening and sustaining institutions and mechanisms for accountability of quality maternal, neonatal and child health services that are equitable and dignified. The network’s strategic objectives reflect the necessity expressed by countries and partners to address quality improvement as part of the unfinished survival agenda stated in the Global strategy for women’s, children’s and adolescents’ health (2016–2030)11 and its related maternal and newborn health action plans.12,13 These objectives also reflect the need to find transformative responses that will support quality improvement in a sustainable way and at scale.14 The stakeholders of the network believe that harmonized and coordinated actions to improve quality of care can make a substantial difference and, with the right investment and focus, can drive progress towards the network’s ambitious goals.15 In all countries participating in the network, investments in improving the quality of care for mothers, newborns and children have often been project-based and fragmented. As a result, these efforts have not been successfully sustained or scaled up. To address this gap, participating countries have developed and are strengthening their national quality of care policies, strategies and institutions for better quality planning, assurance and improvement. Furthermore, participating governments and implementing partners, through the countries’ strategic coordinating committees, have joined forces to align and harmonize their quality improvement actions, including for maternal and newborn services provided in health facilities. Actions to improve quality of care have to be informed by evidence. The WHO document Standards for improving quality of maternal and newborn Leadership, action, learning and accountability to deliver quality care for women, newborns and children Abosede Adeniran, Andrew Likaka, Anneka Knutsson, Anthony Costello, Bernadette Daelmans, Blerta Maliqi, Daniel Burssa, Joseph Freer, Ian Askew, Lisa Bowen, Lily Kak, Lori McDougall, Nabila Zaka, Özge Tunçalp, Petra Tenhoope-Bender, Shamsuzzoha Babar Syed, Stefan Swartling Peterson, Thiago Luchesi, Willibald Zeck, Wilson Were, Pierre Barker & Zainab Naimy