Background

Maternal and newborn mortality remain high in low-resource settings, including Malawi, Bangladesh and Uganda and the other six countries involved in the quality of care network. With increasing rates of births in hospitals across low-income settings including Malawi, there is a need for health system interventions that optimise quality of care so that further reductions in mortality can be achieved despite resource constraints. To tackle a shared low- and middle-income country (LMIC) need for improved labour, childbirth and new-born care the World Health Organisation (WHO) and global partners launched a ‘global network’ approach called The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) in 2017. Their aim is for member countries to learn from each other about which approaches and practices to improving quality of care may work best in which circumstances to achieve shared health outcome goals. The QCN, which initially involves nine countries including Malawi, aims to promote coordination between partners while emphasising country ownership and leadership, and shared learning. The network will run for 5 years up to 2022. Research on whether and how purposefully created networks might leverage global, national and local change is however, sparse.

Against this background, Parent and Child Health Initiative (PACHI) in collaboration with the University College London (UCL) is conduction a 3-year study both at national level and 4 districts at local level to evaluation the Quality of Care Network (QCN) in Malawi. The primary local level study sites are; Mangochi District Hospital, Thyolo District Hospital, Zomba Central Hospital, Kasungu Thyolo District Hospital and Thyolo District Hospital. The study seeks to examine how QCN is constructed in Malawi, its operations and their effects, focusing on network actors (individuals and organizations). The study evaluates five years of QCN activity using both retrospectively (2016-2019) and prospectively (2019-2022) collected data (surveys, interviews, observations) to examine what aspects of the QCN work best and how it influences global, national, and local levels by tackling two research questions namely:

1. National level: What shapes the relationship between country teams and the global network leadership and how does this influence ownership of the policy and management work that is required to set national aims and improve services, and which characteristics of the health system context appear to influence this?
2. Local level: What specific form does national QCN activity take and how does this influence which specific interventions are delivered, which of these are felt to be successful by local actors and which lead to measurable changes in processes and outcomes?

The evaluation is also expected to roll out to other facilities outside the Quality of Care Network in order to have a parallel image as to what is happening in in the other facilities in relation to the quality of care indicators being evaluated in the study.