Fernando Althabe|Eduardo Bergel|María Luisa Cafferata|Luz Gibbons|Agustín Ciapponi|Alicia Alemán|Lisandro D. Colantonio|Alvaro Rodríguez Palacios
Strategies for improving the quality of health care in maternal and child health in low? and middle?income countries: an overview of systematic reviews
Instituto de Efectividad Clínica y Sanitaria|World Health Organization|Instituto de Efectividad Clínica y Sanitaria|Instituto de Efectividad Clínica y Sanitaria|Instituto de Efectividad Clínica y Sanitaria|Instituto de Efectividad Clínica y Sanitaria
many systematic reviews continuing education programmes educational strategies quality improvement health care reviewed studies oneoff evaluations rather impact evaluations longterm followup systematic reviews organisational financial regulatory interventions highquality studies interventions probably important educational strategies although less well evaluated studies undertaken low middleincome countries lmic address maternal child health mch thus results available studies reviews need interpreted cautiously applied lmic interactive workshops reminders multifaceted interventions improve professional practice generally moderate effects educational outreach visits consistently improve prescribing variable effects behaviours audit feedback interventions variable effects professional practice often small moderate effects massmedia patientmediated interventions may change professional practice multifaceted interventions combine several qualityimprovement strategies also effective may single interventions strategies applicable mch lmic applicability results rural settings particular may limited use strategies could exacerbate inequalities taken consideration planning implementation scaling sustainability may difficult achieve lmic contexts need careful consideration use financial interventions well studied financial incentives disincentives may difficult use effectively efficiently although impact practice needs considered organisational interventions likely important given often underlying organisational system problems regulatory interventions well evaluated may sometimes inexpensive effective magic bullets simple solutions ensuring quality health care services interventions selected tailored address underlying reasons failure deliver effective services decisionmakers select appropriate interventions specific problems requires governance structure clearly assigns responsibility qualityimprovement activities priority setting selection design interventions evaluation