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.