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Overview

The purpose of the Maternal, newborn, child, adolescent health, and ageing and quality of care indicator metadata toolkit: Indicator validation guide is to provide Maternal Newborn Child and Adolescent and Healthy Ageing programme managers with information to understand the basic concepts of indicator validation.

This document provides some examples of methods for research on indicator validation and testing. It also includes recommendations on the following:

• Providing information on defining, designing and conducting indicator validation studies for MNCAH and healthy ageing populations, as well as QoC indicators for these groups.
• Offering instructions on interpreting and applying available evidence to evaluate whether given indicators meet desired standards of validity.
• Highlighting the importance and value of assessing the validity of different types of indicators specific to MNCAH, healthy ageing and quality of care.
• Offering specific recommendations on methods for conducting indicator validation studies.

This document is part of Maternal, newborn, child, adolescent health and ageing and quality of care indicator metadata toolkit that has been developed to facilitate monitoring at various levels and can be found here https://platform.who.int/data/maternal-newborn-child-adolescent-ageing/indicator-toolkit/adolescent-health-indicators.  The toolkit includes functionality to search for metadata information for priority indicators.

This editorial highlights the alarming rates of maternal mortality in the country, emphasizing the urgent need for comprehensive reforms to improve healthcare access and quality for women.

Overview

The purpose of this workbook is to assist ministries of health, health managers and practitioners in engaging with the private sector on delivery of quality maternal, newborn and child health (MNCH) services in lower- and middle-income countries. Private health care is one of the fastest growing segments of the health-care system in lower- and middle-income countries, and private providers are an important source of health care. To accelerate progress to reach the Sustainable Development Goals for ending preventable maternal, newborn and child deaths, it is critical that whole health system organizations invest not only in increasing coverage of interventions, but also in quality. The audience for the workbook is those who are involved with organizing and implementing processes for engaging the private sector in delivery of quality MNCH services.

The World Health Organization (WHO) and the UN’s Special Programme on Human Reproduction (HRP) launched a series on maternal and newborn care for a positive postnatal care experience in BMJ Global Health with six articles presenting evidence on the importance of understanding women’s, parents’, and health workers’ perspectives and rights-based approach to strengthen quality postnatal care, for every woman and newborn, everywhere.

NEST360 is an international alliance united to end preventable newborn deaths in African hospitals. The alliance works to deliver a package of technologies and services that enable local governments to save newborn lives, improve newborn outcomes, and empower the medical workforce for the future. There are a number of resources available to support clinicians, engineers and administrators to implement an evidence-based model for sustainable, high-quality hospital-based newborn care in limited resource settings, including clinical and technical resources, technology resources, implementation resources, and COVID-19 related resources.

The Healthy Newborn Network (HNN) is an online community dedicated to addressing critical knowledge gaps in newborn health. HNN brings together partner organizations and individuals working in newborn health to share key resources, data, experiences, and lessons and helps increase global commitment to the advancement of newborn health. It also provides a platform for stakeholders to engage in discussions and working group activities on the vast range of newborn and maternal health topics.

Bohren et al’s opinion piece in The Lancet series emphasizes the critical need to address the complex interplay of gender power dynamics and systemic inequities in maternal health. By employing an intersectional approach, the researchers highlight how factors such as racism, ethnic discrimination, and gendered power relations intersect to exacerbate health disparities. The study advocates for a shift from merely assessing healthcare coverage and usage to focusing on the quality of care, dignity, and justice experienced by women. It underscores the importance of integrating equity-informed interventions and policies that recognize and address these intersecting forms of oppression. The authors call for comprehensive strategies that not only improve maternal health outcomes but also promote social justice and equity, ensuring that all women receive respectful and high-quality care during childbirth.

Summary

Implementation of KMC is central to achievement of the SDGs for the survival, health and well-being of preterm or LBW infants, both well and sick, through its successful scale-up at all levels of facility care and in the community. Based on the new evidence on successful scale-up of KMC in programmatic settings from several countries, complemented by the joint wisdom and experience of global stakeholders, this implementation strategy is intended to guide the way forward for universal coverage of KMC for all preterm or LBW infants, both well and sick. This implementation strategy is meant to inspire a renewed vision in which mothers and infants are kept and cared for together from birth, and where parents and families play a central role in the care of their infants, thus humanizing health care.

Highlights

Achieving KMC implementation at scale requires:

• A system-wide perspective and structural changes to place mothers and infants at the center of care by keeping and caring for them together after birth
• A commitment by political and program leadership to implement KMC as the foundation of small and/or sick newborn care
• A dedicated budget for implementing KMC as part of small and/or sick newborn care in national maternal, newborn and child health programs
• Developing and implementing a monitoring and evaluation framework to track progress.

How to Use

KMC has been shown to be an essential intervention superior to standard radiant warmer/incubator care in all settings. All countries, irrespective of their income setting and resource availability, should adapt this strategy to their health system contexts to realize the full impact of KMC in improving the survival, health and well-being of mothers and preterm or LBW infants alike.

Summary

The purpose of this document is to put forward the joint position and vision of an expert, global, multi-stakeholder working group on implementing KMC for all preterm or LBW infants as the foundation for small and/or sick newborn care within maternal, newborn and child health programs, and spur collaborative global action. Reversing the long-standing inequities in health care will require prolonged efforts; the scale-up of KMC as an essential service for all mothers and their preterm or LBW infants as a critical component of universal health coverage can serve as the key starting point.

Highlights

• Kangaroo mother care (KMC) is an intervention that enables the mother to take a central role in her own and her newborn’s care, thereby ensuring the power stays with the mother, and health workers support and respond to the mother’s and newborn’s needs.
• It humanizes maternal and newborn care by empowering and involving those who care most for the infant, rather than focusing predominantly on technological solutions.
• KMC can serve as a starting point for broader health-system redesign and service delivery transformation for maternal and newborn care, and a model of what can be accomplished when relevant stakeholders are empowered to play the roles naturally entrusted to them in the care of their newborns.

How to Use

Operationalizing this concept can serve as a strong foundation of highly efficient health systems that are rooted in the communities they serve and focus not only on preventing and treating illness but also on improving well-being and quality of life.

Summary

Born too soon: decade of action on preterm birth looks to the future, setting an ambitious agenda to reduce the burden of preterm birth by addressing factors outside of the health system that affect preterm birth; and, within health systems, by providing high-quality, respectful care for women and babies so that they can survive and thrive, no matter where they are born. 

Highlights

• Of every 10 babies born, 1 is preterm – and every 40 seconds, 1 of those babies dies
• Preterm birth rates have not changed in the past decade in any region of the world
• The impacts of conflict, climate change, COVID-19 are increasing risks for women and babies everywhere
• Action is needed urgently to improve the prevention of preterm birth, alongside better care for affected babies and their families

How to Use

This report is intended to inspire and support country-led action: politicians, policy-makers and leaders of all stakeholder groups are its primary audience. However, leadership “from the top” often emerges in response to a unified call to action by a broad-based coalition of committed advocates “from the bottom”.

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

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.