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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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  • Zoe Dettrick
  • Sonja Firth
  • Eliana Jimenez Soto

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.

Suggested Citation

  • Zoe Dettrick & Sonja Firth & Eliana Jimenez Soto, 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, Public Library of Science, vol. 8(12), pages 1-1, December.
  • Handle: RePEc:plo:pone00:0083070
    DOI: 10.1371/journal.pone.0083070
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    References listed on IDEAS

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    1. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 735-769.
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    1. Ashrita Saran & Howard White & Kerry Albright & Jill Adona, 2020. "Mega‐map of systematic reviews and evidence and gap maps on the interventions to improve child well‐being in low‐ and middle‐income countries," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(4), December.
    2. Zoe Dettrick & Hebe N Gouda & Andrew Hodge & Eliana Jimenez-Soto, 2016. "Measuring Quality of Maternal and Newborn Care in Developing Countries Using Demographic and Health Surveys," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-20, June.
    3. So O'Neil & Divya Vohra & Matthew Spitzer & Shveta Kalyanwala & Dana Rotz, "undated". "Maternal Health Care Quality and Outcomes Under the Utkrisht Impact Bond: Midline Findings and Insights," Mathematica Policy Research Reports 159825ed8e034ce396cd6422c, Mathematica Policy Research.
    4. Cheryl A. Vamos & Tara R. Foti & Estefanny Reyes Martinez & Zoe Pointer & Linda A. Detman & William M. Sappenfield, 2023. "Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review," IJERPH, MDPI, vol. 20(11), pages 1-19, May.
    5. So O'Neil & Divya Vohra & Emma Pottinger, "undated". "Legacy of the MacArthur Foundation’s Maternal Health Quality of Care Strategy in India," Mathematica Policy Research Reports efa25a382b5f430c994a4e05f, Mathematica Policy Research.

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