Facilitating quality improvement activities related to newborn care in low- and middle-income countries: challenges and possible solutions.

Global strategies to improve newborn survival have expanded from basic Essential Newborn Care practices to more comprehensive approaches that address the specific needs of small and sick newborns. Despite advances, many low- and middle-income countries continue to face challenges in reducing neonatal mortality, necessitating supportive, evidence-based approaches such as quality improvement activities. Quality improvement focuses on empowering healthcare teams to identify and address gaps in care, with studies demonstrating its superior impact compared to traditional training and/or supervision. As we gain more experience applying it to improve newborn care, we need to learn from early efforts and adapt steps as required. This paper outlines four areas that program managers including teaching instructors can address to strengthen quality improvement efforts: (1) adapting quality improvement structures and training, (2) simplifying related tools and methods for ease of use at the frontline, (3) prioritising specific newborn health improvement goals with appropriate data and relevant indicators, and (4) strengthening health system elements to sustain the quality improvement initiatives. The paper describes challenges in each of these areas and proposes potential solutions. While point-of-care approaches are vital, it is equally essential to engage communities, foster leadership at all levels, promote equity and strengthen health systems, especially in low- and middle-income countries. This includes establishing regional and national technical bodies and strategies, working with ministries of health, stakeholders, and professional associations, to ensure sustainability, equity, and expansion of quality newborn care.