Intended for healthcare professionals

Quality of Care

Stemming from widespread agreement on the urgency and importance of improving quality of care for universal health coverage in low- and middle-income countries, efforts to apply evidence on quality measurement and improvement at the country level - and to fund and implement innovative approaches for large-scale change - have proliferated in the past five years. Despite progress toward improving quality of care, there are persistent challenges to sustainably integrating quality improvement efforts into national health systems. Challenges, for example, relate to health management capacity, strengthening accountability mechanisms, demonstrating impact through measurement, and systematically involving communities to improve quality of care. The covid-19 pandemic laid bare additional challenges, including the importance of maintaining provision of quality care during emergencies and in vulnerable settings.

This BMJ collection, in collaboration with the World Health Organization and the World Bank, offers critical thinking on both the unfinished agenda and emerging priorities for improving quality of care in low- and middle-income countries. Examples are primarily drawn from maternal, newborn and child health to illustrate current issues that warrant further attention and action as well as new and evolving opportunities for ensuring all people have access to quality health services.


Enable, engage, and innovate for quality
An approach to consistently deliver quality healthcare to everyone, everywhere


Service delivery redesign is a process, not a model of care
Sanam Roder-DeWan and colleagues call for wider application of the principles of service delivery redesign to provide accessible, high quality services across healthcare.

Prepared health systems provide quality care at all times
Blerta Maliqi and colleagues argue that capacity of a health system to provide good quality care even during health crises can save lives and is a strong indication of its resilience.

Regular measurement is essential but insufficient to improve quality of healthcare
Ambrose Agweyu and colleagues argue that large scale improvements in quality of healthcare require strong change management as well as health information systems that can provide continuous and rapid feedback.

Networks of care to strengthen primary healthcare in resource constrained settings
Networks of care are a promising way to provide support and resources for isolated primary care workers and deserve more research, argue Enoch Oti Agyekum and colleagues.

Facilitators of co-leadership for quality care
Olive Cocoman and colleagues argue that national leadership for quality of care requires working in a co-leadership model such that quality and programme units have equal standing and clearly defined individual roles and responsibilities.

Delivering quality care to all mothers and newborns requires governments to engage the private sector
More structured engagement with the private sector will contribute to achieving universal health coverage with quality, argue Rajat Chabba and colleagues

Institutionalising community engagement for quality of care: moving beyond the rhetoric
Community engagement has the potential to improve quality of care but is poorly represented in policy and the literature; its institutionalisation in health systems must be supported, argue Brynne Gilmore and colleagues

Implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond
Michael Peters and colleagues argue that concerted efforts to embed implementation research can improve health services, even in the most challenging operating environments

The politics of health system quality: The challenge of igniting demand
Kevin Croke and colleagues consider how demand for quality health systems can be made a political and public priority to drive change in low and middle income countries


Decolonisation and quality of care
Delivering high quality healthcare for all requires recognising the legacies of colonialism in driving power asymmetries and producing inequitable health outcomes both within and between countries say Bernice Yanful and colleagues.

Embedding quality in primary healthcare
Quality of care must be a central focus of efforts to strengthen primary healthcare in the drive for universal health coverage, write Federica Secci and Shams Syed.

Quality of care reform: a case for systems thinking and human centred design capabilities
Elizabeth Mitgang and colleagues argue that building capacity in applied systems thinking and human centred design mindsets and methods can help improve quality of care, particularly in low and middle income settings

A motivated workforce is needed for quality improvement efforts to succeed
Minara Chowdhury and colleagues reflect on workforce motivation for quality improvement projects in maternal and newborn healthcare in Bangladesh

Continuous measurement of quality is vital for improving care for women, newborns, and children in Nigeria
Ugo Okoli and colleagues argue that much can be learnt from Nigeria’s efforts to strengthen continuous measurement of quality using routine data sources to help improve quality of care for women and children

This collection was proposed by the World Health Organization and the World Bank and the articles were commissioned by The BMJ. The BMJ peer reviewed, edited, and made the decision to publish these articles. Article handling fees are funded by the Bill and Melinda Gates Foundation. Jennifer Rasanathan, Juan Franco, and Emma Veitch edited this collection for The BMJ. Regina Kamoga was the patient editor.

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