Quality Assurance and Quality Improvement in Maternal, Infant, Young Child and Adolescent Nutrition Service Provision in Five Countries.

Greater efforts are needed to better integrate nutrition services focused on the first 1000 days into health systems. Key constraints to large-scale impact include the scale of coverage, intensity and quality of nutrition services. But there is little understanding to date on what quality comprises in the context of maternal, infant, young child and adolescent nutrition (MIYCAN) services. This qualitative assessment presents findings from five countries (Bangladesh, Burkina Faso, Cambodia, Ethiopia, and India) where Alive and Thrive (A&T) addressed the quality of MIYCAN services to understand the quality frameworks used, components addressed and factors that can improve the quality of MIYCAN services. The methodology consisted of reviewing programme documents and conducting purposive key informant interviews (n = 30) with A&T country staff and stakeholders involved with MIYCAN service provision supported by A&T technical assistance (TA). Countries used either health-system-level quality assurance (QA), largely systems strengthening, or facility-level continuous quality improvement (QI) that used an iterative process to improve service quality. Joint pilot interventions supported by A&T and respective country governments demonstrated that implementing QA/QI to improve MIYCAN services was feasible. Common QA/QI activities included improving nutrition standards of care, harmonising training materials, changing how services were delivered, altering counselling from didactic to dialogue-oriented and promoting the strategic use of data to address service provision challenges and identify solutions. Factors that facilitated QA/QI included working jointly with the government. The findings suggest that there are common principles that can guide the development of future MIYCAN programmes with similar objectives.