Dear Neil, Massimo and Friends,
I agree that quality improvement is very challenging in LMICs. At the same
time, further improvement in mortality rates and nature of survival will be
significantly influenced by improved quality of care. I sincerely feel that
we have to persist both with external facilitation and increased in-country
motivation and support, with adaptation of some of the guidelines to better
suit and address the challenges existing in LMICs.
I have been interested in quality of care in low- and middle-income
countries (LMICs) for quite some time now and have developed manuscripts
that are in the phase of being reviewed (fingers crossed!). One of them
covers experiences in facilitating QI activities in LMICs, the challenges
and possible solutions.
I support the WHO concept of “point of care quality improvement” of
commencing feasible activities using available resources, without waiting
for the government/health system to provide all the necessary support. At
the same time, it will be beneficial if, with every facilitation of QI
processes, facilitators, both external from outside agencies and within the
relevant country along with participants, make attempts to whatever extent
that is feasible, even if it is, at the beginning, only advocacy, to
strengthen relevant health system pillars to promote expansion and
sustainability addressing equity.
I will share the articles, after they, hopefully, get published! I’m
afraid, whether we like it or not, unless we can initiate something better,
quality improvement is here to stay!
Warm regards,
Indira
CHIFA Profile: Indira Narayanan is currently Adjunct Professor, Pediatrics/Neonatology at the Georgetown University Medical Center, Washington DC, USA and Independent Consultant, Global Maternal and Newborn Health. Professional interests: Maternal and Newborn Health, research, improving newborn care with emphasis on compassionate/respectful quality of care, health policies, program implementation, capacity building, social and behavior change communication. Her research includes the seminal randomized controlled studies on proving for the first time in world literature the clinical implications of the anti-infective properties of raw and heated human milk in neonatal units carried out during her work of 20 years in India. inarayanan6 AT gmail.com