Individual, organizational and system circumstances, and the functioning of a multi-country implementation-focused network for maternal, newborn and child health: Bangladesh, Ethiopia, Malawi, and Uganda.
Individual, organizational and system circumstances, and the functioning of a multi-country implementation-focused network for maternal, newborn and child health: Bangladesh, Ethiopia, Malawi, and Uganda.
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DOI：
10.1371/journal.pgph.0002115
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Marchant, Tanya
中科院分区：
文献类型：
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作者：
Tesfa, Anene;Nakidde, Catherine;Akter, Kohenour;Khatun, Fatama;Mwandira, Kondwani;Lemma, Seblewengel;Seruwagi, Gloria;Mwaba, Kasonde;English, Mike;Daniels-Howell, Callie;Djellouli, Nehla;Colbourn, Tim;Marchant, Tanya
需要更好的政策、投资和计划来改善孕产妇、新生儿和儿童健康服务的整合和质量。以往，涉及多个国家的具有统一目标的伙伴关系和协作已被观察到产生积极成果。自2017年以来，世卫组织及其合作伙伴主办了护理质量网络（QCN），这是一个专注于改善孕产妇、新生儿和儿童卫生保健的多国实施网络。在本文中，我们研究的功能QCN在不同的上下文中。我们专注于四个网络国家的实施情况和背景：孟加拉国，埃塞俄比亚，马拉维和乌干达。在每个国家，该研究在2019-2022年期间连续进行了几轮，对主要利益相关者和网络国家成员进行了227次关键信息人访谈，并进行了42次设施观察。使用Nvivo-12软件对收集的数据进行编码，并按主题进行分类。研究表明，个人、组织和系统层面的情况都对网络国家的执行成功发挥了重要作用，但这些层面是相互关联的。能够发挥领导作用、激励和培训工作人员并创造积极的数据使用文化的系统，对于决策，包括解决筹资问题以及改善一线的日常做法至关重要。QCN的一些特点积极支持这一点，例如，用于持续学习的共享学习论坛，注重数据和跟踪进展，并强调协调努力实现共同目标的重要性。然而，系统资金和能力不足也阻碍了网络的运作，特别是在面临外部冲击的情况下。
Better policies, investments, and programs are needed to improve the integration and quality of maternal, newborn, and child health services. Previously, partnerships and collaborations that involved multiple countries with a unified aim have been observed to yield positive results. Since 2017, the WHO and partners have hosted the Quality of Care Network [QCN], a multi-country implementation network focused on improving maternal, neonatal, and child health care. In this paper, we examine the functionality of QCN in different contexts. We focus on implementation circumstances and contexts in four network countries: Bangladesh, Ethiopia, Malawi, and Uganda. In each country, the study was conducted over several consecutive rounds between 2019–2022, employing 227 key informant interviews with major stakeholders and members of the network countries, and 42 facility observations. The collected data were coded using Nvivo-12 software and categorized thematically. The study showed that individual, organizational and system-level circumstances all played an important role in shaping implementation success in network countries, but that these levels were inter-linked. Systems that enabled leadership, motivated and trained staff, and created a positive culture of data use were critical for policy-making including addressing financing issues—to the day-to-day practice improvement at the front line. Some characteristics of QCN actively supported this, for example, shared learning forums for continuous learning, a focus on data and tracking progress, and emphasising the importance of coordinated efforts towards a common goal. However, inadequate system financing and capacity also hampered network functioning, especially in the face of external shocks.