Advancing the quality of maternal, newborn, and child healthcare: insights from pilot hospitals in the Kyrgyz Republic.

Background: Maternal, newborn, and child mortality rates in the Kyrgyz Republic are high compared to other countries in the European Region of the World Health Organization (WHO). Global evidence suggests that at least half of the maternal and newborn deaths could be prevented with improved quality of healthcare. To address this, we undertook a quality improvement project over two years in ten pilot hospitals of the Kyrgyz Republic. Methods: We assessed the quality of care for maternal, newborn, and child health using WHO tools at the beginning and end of the project. We evaluated the availability and appropriate use of resources, case management, and key hospital policies. We used a standardised scoring system from 0 to 3, with colour coding scores and a display of trends (improved, deteriorated, remained the same). After the baseline assessment, we conducted a complex improvement process including the development of hospital quality improvement plans, updating clinical guidelines, training activities in priority topics, supportive supervision, and semi-annual collaborative quality improvement meetings between hospitals. Results: The baseline assessment revealed many areas of suboptimal care across the hospitals and technical areas. The endline assessment showed improvements in case management practices (baseline mean (x̄) = 1.6 vs. endline x̄ = 1.9) and policies and organisation of services (baseline x̄ = 1.7 vs. endline x̄ = 1.9). No improvement was achieved in hospital support services (baseline x̄ = 1.7 vs. endline x̄ = 1.8). Eight out of ten hospitals demonstrated overall improvement progress across categories; the two remaining hospitals showed no improvement. Conclusions: A complex intervention process focussed on updating clinical guidelines, selected capacity-building activities, supportive supervision, and semi-annual collaborative meetings led to quality improvements in maternal, newborn, and child health. The improvements achieved were still not reaching international standards, highlighting the need for a comprehensive and system-wide approach to quality improvement.