Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview.
OBJECTIVE
Conduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children.


METHODS
Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews.


METHODS
Health systems of all countries. Study outcome: QoC measured using surrogate indicators--effective, efficient, accessible, acceptable/patient centred, equitable and safe.


METHODS
Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers.


RESULTS
We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework--information, patient-population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, 'communication' and 'satisfaction', were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups.


CONCLUSIONS
The barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all.
National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK.
Manisha
M
Nair
Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
Sachiyo
S
Yoshida
Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
Thierry
T
Lambrechts
Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
Cynthia
C
Boschi-Pinto
Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
Krishna
K
Bose
Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
Elizabeth Mary
EM
Mason
Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
Matthews
M
Mathai
D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038622:Internationality; D000068101:Maternal-Child Health Services / Q000592:standards*; D011247:Pregnancy; D058996:Quality Improvement; D011787:Quality of Health Care
Public Health