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

Dettrick, Zoe, Firth, Sonja and Jimenez Soto, Eliana (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: 1-9. doi:10.1371/journal.pone.0083070


Author Dettrick, Zoe
Firth, Sonja
Jimenez Soto, Eliana
Title 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
Journal name PloS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2013-12-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1371/journal.pone.0083070
Open Access Status DOI
Volume 8
Issue 12
Start page 1
End page 9
Total pages 9
Place of publication San Francisco, United States
Publisher Public Library of Science
Language eng
Formatted 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.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article e83070.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Public Health Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 17 Dec 2013, 00:46:43 EST by Eliana Jimenez Soto on behalf of School of Public Health