^{The UN Resident Coordinator visits Mzimba District in Malawi to acknowledge and appreciate the successful implementation of the UN Joint Project on Quality of Care as part of ongoing district health system strengthening efforts.}
Photo credit: WHO Malawi.

To ensure effective governance and coordinated investment in QoC interventions, WHO provided technical support to the MoH in Malawi to develop the National Quality Management Policy in 2017. This policy aligned with Malawi’s Health Sector Strategic Plan II (2017–2022), National Quality Management Strategy (2017–2022), National MNCH Quality of Care Roadmap (2017–2022), MNCH Quality of Care Standards and Assessment Tools, and National Quality of Care Standards (2022). Moreover, WHO adapted its global standards and assessment tools for maternal, newborn, and paediatric care to the Malawi context in 2017, 2019 and 2021, respectively, and updated and disseminated MNCH guidelines in 2021. These efforts facilitated the establishment of a coordinated and integrated quality management system at all levels, from national to facility.

WHO and the MoH engaged stakeholders and established a National Coordination Committee that identified nine learning districts and appointed QoC focal points to guide district-level initiatives and support facility-level improvements. Nine MNCH QoC standards were then introduced to 37 health facilities in the nine districts via training, supportive supervision and mentorship, for which WHO provided technical and financial support. This included collaborative learning sessions for health workers to share experiences and progress on their QI projects, with the aim of widespread uptake of successful QoC initiatives. After refining the intervention in the initial districts, it was scaled up to the national level by training more than a thousand health workers. As a result, 280 health facilities initiated over 300 MNCH QI projects. These included Thyolo district hospital, whose success in reducing maternal and neonatal mortality was attributed to its emphasis on maternal death audits and review of near misses, improved monitoring of pregnant women in labour through the development of monitoring tools, continued professional development activities, improvement in referral systems, allocation of ambulances in clusters and ongoing clinical mentorship of health workers. To facilitate the analysis of key MNCH QoC indicators for the improvement of health service delivery, WHO provided technical support and data visualization tools to over 120 targeted facilities.

“The MNH Quality Improvement mentorship programme was an exceptional training experience. Not only did we receive comprehensive refresher training, but we also benefited from monthly visits by national mentors. After participating in five mentorship visits, my knowledge and skills in QI have improved. I have been able to assist my work improvement team and colleagues in other health facilities to enhance the quality of care we provide."

-          Mentee from Kasungu District

In 2022, WHO provided technical and financial support to the MoH to launch an online continuing professional development (CPD) platform, aiming to sustain QoC training in the long term. Over 500 health workers enrolled to use the platform. In October 2022, the Minister of Health officially opened the National QoC Conference, engaging 400 district health officers, facility staff and other stakeholders. To further support learning and knowledge sharing, the MoH’s Quality Management Directorate is working with academia to establish a national learning centre.

“I have gained a wealth of knowledge and skills in Quality Improvement through my mentorship experience. My leadership skills have been greatly enhanced and I am now confident in my ability to mentor others in healthcare Quality Improvement. We have achieved a lot through the projects in our health facilities. For example, in 2022 we successfully reduced puerperal sepsis cases from 7.4% to 1.7%, and asphyxia cases from 3.2% to 1.5%.“

-          Mentee from Thylo District

Collaborative learning – where districts share their experiences, adapt them to their own settings and rapidly test changes – has proved valuable for deriving collective strategies for the continuity of essential health services and recovery following multiple emergencies, including COVID-19. In 2021, the Ministry of Health conducted an evaluation of the perinatal death surveillance and response (MPDSR) programme, which identified gaps in staff training and involvement and proposed solutions, including the integration of MPDSR within quality improvement (QI) efforts and the institutionalization of perinatal death audits and verbal autopsy. An evaluation of the Network for Improving Quality of Care for Maternal, Newborn, and Child Health’s QoC initiative is currently under way and will guide strategic action in the next phase of the initiative.