Opportunities to sustain a multi-country quality of care network: Lessons on the actions of four countries Bangladesh, Ethiopia, Malawi, and Uganda.
Opportunities to sustain a multi-country quality of care network: Lessons on the actions of four countries Bangladesh, Ethiopia, Malawi, and Uganda.
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DOI：
10.1371/journal.pgph.0001672
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发表时间：
2023
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护理质量网络（QCN）是一项全球倡议，于2017年在世卫组织的领导下在11个中低收入国家建立，旨在改善孕产妇、新生儿和儿童健康。设想护理质量网络将在成员国内建立，并在最初的执行期之后继续存在：该网络将持续下去。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而采取的行动的经验，并报告了所吸取的教训。通过与全球和国家利益攸关方的定性访谈以及对卫生设施和会议的非参与性观察，进行了多轮反复的数据收集。共进行了241次访谈、42次设施和4次会议观察。我们使用框架方法对所有数据进行了主题分析，该方法定义了可以采取的六项关键行动来促进可持续发展。分析表明，这四个国家都不同程度地采取了这些关键行动。尽管观察到了脆弱性，但有充分证据表明，已采取行动，使卫生系统内的创新制度化，激励微观一级的行为者，从一开始就规划反思和适应的机会，并支持强有力的政府所有权。有两项行动基本上没有采取，削弱了对未来可持续性的信心：管理财政不确定性和促进社区自主权。来自四个国家的证据表明，快速通道网络模式将无法以其原始形式持续下去，主要原因是财政脆弱性和没有足够的时间将创新纳入国家以下一级。但是，特别是努力使现有系统的创新制度化，这意味着QCN的一些特点可能会在更广泛的政府质量改进计划中得到发扬。
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.