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    Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence.

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    Author
    Dettrick, Z; Firth, S; Jimenez Soto, E
    Date
    2013
    Source Title
    PLoS One
    Publisher
    Public Library of Science (PLoS)
    University of Melbourne Author/s
    Firth, Sonja
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Dettrick, Z., Firth, S. & Jimenez Soto, E. (2013). Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence.. PLoS One, 8 (12), pp.e83070-. https://doi.org/10.1371/journal.pone.0083070.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253692
    DOI
    10.1371/journal.pone.0083070
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857295
    Abstract
    OBJECTIVES: Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. METHODS: We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. FINDINGS: Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. CONCLUSION: Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.

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