How does a multi-country, multilateral network focused on specific health care improvements evolve and what shapes its ability to achieve its goals?

在资源匮乏的环境中，孕产妇和新生儿死亡率仍然很高，包括马拉维、孟加拉国和乌干达，这三个国家是本建议的重点国家，另外六个国家参与了我们寻求评估的护理质量网络。随着马拉维、孟加拉国和乌干达等低收入国家医院分娩率的上升，有必要采取卫生系统干预措施，优化护理质量，以便在资源有限的情况下进一步降低死亡率。为了解决中低收入国家对改善分娩、分娩和新生儿护理的共同需求，世界卫生组织（世卫组织）和全球合作伙伴正在采取一种名为“提高孕产妇、新生儿和儿童健康护理质量网络”的“全球网络”方法。他们的目的是让各国相互学习，了解哪些提高护理质量的方法在哪些情况下最有效，以实现共同的健康成果目标。QCN最初涉及9个国家，旨在促进合作伙伴之间的协调，同时强调国家所有权和领导权以及共享学习。虽然卫生网络方面的工作正在出现，但这些工作大多来自高收入国家，或侧重于提请注意全球卫生问题的网络，而不是实施变革的网络。然而，关于有目的地创建的网络是否以及如何利用全球、国家和地方变化的研究很少。因此，我们打算利用世卫组织及其合作伙伴启动QCN的机会，研究它是如何构建的，它的运作及其影响。该网络于2017年2月启动，但迄今为止尚未委托外部评估。考虑到这个新的QCN的规模和雄心，它所涉及的投资以及它可能影响国际卫生组织和捐助者未来运作方式的可能性，需要对其进行研究。我们建议回顾性（2016-2018年）和前瞻性（2018-2022年）评估QCN的哪些方面工作最好，它如何影响全球，国家和地方各级的努力，以及它如何桥接这些级别之间的接口（见目标摘要中的研究问题）。我们的工作将借鉴有关网络组织和结构的理论，网络的出现和有效性，政策过程（政策制定，制定，决策，实施和评估），权力和机构的性质与结构，以及创新的扩散。鉴于可用于这一筹资呼吁的资源有限，我们选择将我们的评价重点放在全球一级和九个国家中的三个国家。我们选择马拉维、孟加拉国和乌干达作为案例研究国家，是基于它们所代表的背景和起点的范围、它们在网络中的初始参与（以便我们有材料进行评估）、现有的研究联系和合作以及参与这项研究的热情。我们将回答我们的研究问题，通过多学科的混合方法的工作方案，旨在实现我们的目标（见目标摘要），通过针对全球一级的QCN，马拉维和孟加拉国的方案作为案例研究，为国家和地方各级，发展理论如何QCN运作。然后，我们将在乌干达测试这一新兴理论，以评估其外部有效性，并完善它在国家和卫生系统的情况下酌情方面。我们的目标是制定可推广的理论，以改善QCN和未来网络的运作，在我们的影响和目标摘要。

Maternal and newborn mortality remain high in low-resource settings, including Malawi, Bangladesh and Uganda, the focus countries of this proposal, and the other six countries involved in the quality of care network we seek to evaluate. With increasing rates of births in hospitals across low-income settings including Malawi, Bangladesh and Uganda, there is a need for health system interventions that optimise quality of care so that further reductions in mortality can be achieved despite resource constraints. To tackle a shared low- and middle-income country (LMIC) need for improved labour, childbirth and newborn care the World Health Organisation (WHO) and global partners are pursuing a 'global network' approach called The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN). Their aim is for countries to learn from each other about which approaches to improving quality of care may work best in which circumstances to achieve shared health outcome goals. The QCN, which initially involves nine countries, aims to promote coordination between partners while emphasising country ownership and leadership, and shared learning. Though there is an emerging body of work on health networks this is mostly from high-income countries or on networks focused on drawing attention to global health issues rather than those implementing change. Research on whether and how purposefully created networks might leverage global, national and local change is however, sparse.We intend therefore to take advantage of the launch of the QCN by WHO and partners and examine how it is constructed, its operations and their effects. The network was launched in February 2017 though, to date, no external evaluation has been commissioned. Given the scale and ambition of this new QCN, the investments it involves and the possibility it could influence the way international health organisations and donors operate in the future, it needs to be studied. We propose to retrospectively (2016-2018) and prospectively (2018-2022) evaluate what aspects of the QCN work best, how it influences efforts at global, national, and local levels and how it bridges the interfaces between each of these levels (see research questions in summary of objectives). Our work will draw on theories concerning network organisation and structure, emergence and effectiveness of networks, the policy process (agenda-setting, formulation, decision-making, implementation and evaluation), the nature of power and agency in relation to structure, and diffusion of innovation. Given available resources for this funding call we have chosen to focus our evaluation at the global level and in three of the nine countries. We have chosen Malawi, Bangladesh and Uganda as case study countries based on the range of settings and starting points they represent, their initial engagement in the network (so that we have material to evaluate), existing research links and collaborations, and enthusiasm to participate in this research. We will answer our research questions via a multi-disciplinary mixed methods programme of work that aims to achieve our objectives (see summary of objectives) by targeting the global level of the QCN, and Malawi and Bangladesh's programmes as case studies for the national and local levels, to develop theory on how the QCN operates. We will then test this emerging theory in Uganda to assess its external validity and refine aspects of it in relation to country and health systems context as appropriate.We aim to develop generalizable theory to improve the operation of the QCN and future networks, as indicated in our impact and objectives summaries.