Quality improvement in maternal, neonatal and child health services in sub-Saharan Africa: A look at five resource-poor countries


  • Tekleab Mekbib
  • Sheila Leatherman


Background: Quality improvement (QI) practices can advance maternal, neonatal and child (MNC) health outcomes. Hence, accelerating QI activities to achieve better results should be encouraged. Objectives: This study aims to review QI interventions by conducting a synthesis of available data.

Methods: A rapid review methodology and the ‘Google Scholar’ search engine were used. We focused on Ethiopia, Ghana, Nigeria, Tanzania and Uganda because their populations are large, they all have a significant burden of MNC deaths, they are all signatories to the Every Newborn Action Plan (ENAP) and members of the Quality of Care (QoC) Network, and all have adopted maternal death surveillance and response (MDSR) systems. We also examined documents on the websites of ENAP, QoC Network, World Health Organization, and the ministries of health of all five countries.

Results: There was a paucity of information on clinical practice guidelines (CPGs), audit and feedback. There was weak integration between national quality policies and strategies and UN initiatives. Only 12 articles and two reports met our inclusion criteria. We found a total of just 20 CPGs on the websites of the various ministries of health. All five countries shared a scarcity of CPGs and poor performance in using MDSR systems.

Conclusions: For successful implementation of QI interventions, it is necessary to establish a mechanism for producing evidence-based CPGs and to revitalize the MDSR system. UN initiatives need to be integrated with national programs for impact and sustainability. While our findings do not allow us to make a causal link between the scarcity of CPGs and inadequate QoC in MNC healthcare services, evaluation of national programs, including UN initiatives, is required. [Ethiop. J. Health Dev. 2020; 34(1):59-80

Key-words: Quality improvement; maternal, neonatal and child health; quality of care; Every Newborn Action Plan; Quality of Care Network; clinical practice guidelines; audit and feedback






Review Article