A systematic, standards-based, participatory assessment of a continuous quality improvement project in Kyrgyzstan and Tajikistan: results for neonatal care.

Background: Progress in reducing neonatal mortality in low- and middle-income countries in Central Asia, such as Kyrgyzstan and Tajikistan, has been slow. We aimed to explore deficiencies in neonatal care quality, highlight areas for improvement, and propose evidence-based actions to promote further progress in both countries. Methods: In this mixed-methods study, we evaluated neonatal care quality before and after a two-year quality improvement (QI) project in nine maternity hospitals in Kyrgyzstan and ten in Tajikistan. Through service visits, medical record reviews, direct observations, and interviews with staff and mothers, a multidisciplinary team of national and international experts and local managers assessed care quality using a tool developed by the World Health Organization, with scores ranging from 0 to 3. The QI cycle included establishing a QI team, developing an action plan, building healthcare providers' capacity, providing supportive supervision, and initiating policy changes, with all initiatives reviewed during semi-annual collaborative QI meetings. Results: At baseline, neonatal care quality was suboptimal (scores 1.0-1.9) across all assessed areas. By the project's conclusion, improvements were seen in routine care (Kyrgyzstan +0.4, Tajikistan +0.5), sick newborn care (+0.6 in both), hospital care accessibility (Kyrgyzstan +0.5, Tajikistan +0.8), and monitoring/follow-up (Kyrgyzstan +0.3, Tajikistan +0.9). Tajikistan also progressed in guidelines, training, audits (+0.8), and maternal/newborn rights (+0.5). However, hospital support services remained below good practice standards (<2.0) in both countries, and no significant improvements (<0.3) occurred in advanced newborn care or infection prevention. Conclusions: Comprehensive QI interventions have led to significant enhancements in neonatal care quality in both Kyrgyzstan and Tajikistan. However, critical gaps persist in certain essential areas that must be addressed. Ongoing, evidence-based QI efforts, alongside close monitoring, nationwide expansion, and strong government support, are essential to guarantee continued progress in these countries.