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

IF 2.8 2区 医学 Q3 NUTRITION & DIETETICS
Kavita Sethuraman, Sujata Bose, Jessica Escobar-DeMarco, Edward A. Frongillo
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Abstract

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.

Abstract Image

五国孕产妇、婴儿、幼儿和青少年营养服务提供的质量保证和质量改进。
需要作出更大努力,更好地将以头1000天为重点的营养服务纳入卫生系统。影响大规模的主要制约因素包括营养服务的覆盖范围、强度和质量。但迄今为止,人们对孕产妇、婴儿、幼儿和青少年营养服务的质量构成知之甚少。本定性评估报告展示了五个国家(孟加拉国、布基纳法索、柬埔寨、埃塞俄比亚和印度)的调查结果,在这些国家,“生存与繁荣”(A&T)研究了MIYCAN服务的质量,以了解所使用的质量框架、所涉及的组成部分和可以提高MIYCAN服务质量的因素。该方法包括审查方案文件,并与A&T国家工作人员和参与在A&T技术援助(TA)支持下提供MIYCAN服务的利益攸关方进行有目的的关键信息提供者访谈(n = 30)。各国要么采用卫生系统级质量保证(QA),主要是加强系统,要么采用设施级持续质量改进(QI),使用迭代过程来提高服务质量。由A&T和各自国家政府支持的联合试点干预表明,实施QA/QI来改善MIYCAN服务是可行的。常见的质量保证/质量改善活动包括改善护理的营养标准、协调培训材料、改变提供服务的方式、将咨询从说教改为以对话为导向,以及促进战略性地使用数据来应对服务提供方面的挑战并确定解决方案。促进QA/QI的因素包括与政府合作。调查结果表明,有一些共同的原则可以指导具有类似目标的未来MIYCAN方案的发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Maternal and Child Nutrition
Maternal and Child Nutrition 医学-小儿科
CiteScore
7.70
自引率
8.80%
发文量
144
审稿时长
6-12 weeks
期刊介绍: Maternal & Child Nutrition addresses fundamental aspects of nutrition and its outcomes in women and their children, both in early and later life, and keeps its audience fully informed about new initiatives, the latest research findings and innovative ways of responding to changes in public attitudes and policy. Drawing from global sources, the Journal provides an invaluable source of up to date information for health professionals, academics and service users with interests in maternal and child nutrition. Its scope includes pre-conception, antenatal and postnatal maternal nutrition, women''s nutrition throughout their reproductive years, and fetal, neonatal, infant, child and adolescent nutrition and their effects throughout life.
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