Effectiveness of quality improvement strategies

As noted in many of the preceding pages there is only limited evidence to show that quality improvement initiatives in Maternal and Newborn Health (MNH) in low and middle income countries (LMICs) actually improve health outcomes (i.e. have an impact).

Why is this?

Most of the systematic reviews that have been conducted have been either limited by the quality of studies, inconclusive or showed no effect on maternal and neonatal outcomes. This includes reviews on maternal and perinatal audit, paying for performance, training of traditional birth attendants and community health workers in delivering preventive interventions.

Some have shown strong evidence of benefit, for example Lassi et al (2010) and Prost et al (2013) reported mortality reductions as a consequence of community-based and women’s participatory strategies.

Assessments of impact, such as the individual trials on audit in Sub-Saharan Africa and women’s groups in Nepal discussed earlier, are becoming increasingly common.

What is the outlook?

The lack of evidence to demonstrate success does not mean that such interventions should be abandoned, but simply that the information available may be too limited to show effects. Many quality improvement interventions show evidence of some benefit in other ways. We will look at some examples in the next section.

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