Improving the quality of care for mothers, newborns, and children in ten hospitals of the Republic of Tajikistan.

Background: Tajikistan has accomplished reductions in maternal, newborn, and child mortality over the past decades through targeted policies and interventions. Challenges remain in providing quality healthcare due to limited resources, geographic barriers, and inadequate infrastructure. We aimed to evaluate the impact of a quality improvement (QI) initiative implemented in ten district hospitals from 2021 to 2024 to improve maternal, newborn, and childcare to accelerate progress towards achieving the Sustainable Development Goals. Methods: A baseline assessment was conducted in 2021, with an endline assessment in 2023, using updated WHO quality assessment tools. A multidisciplinary team of national and international experts evaluated hospital performance across three domains: support systems, clinical management, and organisation of care. Data was collected through observations, interviews, and medical record reviews. Project interventions included working with hospital-level Quality Improvement committees, capacity building in effective perinatal care, and the use of the WHO Pocketbook of Hospital Care for Children. Regular supportive supervision and half-yearly collaborative quality improvement meetings were held among the ten hospitals. We graphically displayed, analysed, and summed the assessment scores. Results: We observed notable improvements in the quality of hospital care, with most facilities progressing from substandard to better-performing categories. Seven out of ten hospitals demonstrated advancements in their maternity and neonatal units, with improvements in clinical management and hospital support systems, including access to drugs and equipment. Challenges remained in paediatric care, with only two of ten hospitals showing improvements in infrastructure and laboratory services, and none improving drug availability. Improvements in infection prevention and control were minimal; however, four in ten hospitals managed to improve their practices despite challenges with resource availability, infrastructure, and current protocols. Conclusions: Comprehensive QI interventions can raise standards of care in resource-limited settings like Tajikistan. Despite measurable progress, systemic barriers persist, with weak infrastructure, unstable workforce, and limited infection prevention and control, requiring targeted investment and political commitment. Sustained success depends on equitable resource allocation, robust monitoring systems, and the promotion of a non-punitive, systems-oriented culture. Scaling up this initiative nationwide is critical to achieving long-term improvements in health.