Quality of inpatient paediatric and newborn care in district hospitals

Abstract

Background: We read with great interest the Viewpoint by Mike English and colleagues on the quality of care for paediatric and newborn patients in district hospitals, published in The Lancet Global Health. The authors focus, in part, on WHO recommendations for measuring paediatric quality of care and small and sick newborn quality of care in health facilities. They report that WHO has published more than 1000 non-prescriptive quality of care indicators to meet measurement needs of key actors and argue that “when presented with such a huge array of indicators, key actors could either feel overwhelmed (and avoid engaging in the quality agenda) or feel under pressure to perform seemingly impossible measurement tasks”. Authors also conclude that presenting multiple indicators to country-level actors bears the “risk of narrowing the gaze of quality improvement to only measuring indicators without implementing subsequent improvement actions”. In the broader view, the Viewpoint by English and colleagues provides valid and important insights about paediatric quality of care measurement and improvement challenges in low-income and middle-income countries, including workforce shortages, data fragmentation, and data quality issues. It also rightfully notes varying data needs at different levels; the importance of quality measurement across the care continuum, service delivery levels, and system categories; the need for better integration of quality of care indicators into routine health information systems; the importance of collaborative consensus building process around quality of care measurement; and governance and accountability.