This document summarizes experiences and conclusions from the MCHP (Maternal and Child Health Program) on improving health outcomes. It discusses implementing a quality of care framework at the facility and health systems levels, including modernizing infrastructure, promoting continuous medical education focused on practical skills, integrating new evidence into care through clinical practice guidelines and protocols, and putting patients at the center. It also covers using information systems to drive change and governance through management training and decentralization to strengthen institutions. The outlook calls for developing a more team-oriented and learning culture oriented towards patient needs through knowledge sharing and integrating new knowledge on an ongoing basis.

1. Towards better health outcomes:
Experiences and conclusions from
the MCHP

2. The wider picture ..
.. Two reference frameworks
Managing Quality
at the facility level
Quality of Care framework
at Health systems level

3. Infrastructure
• Modernising facility standards
and management
• Referral systems / services
package
• Modernising equipment, but with
a view to recurrent cost
• Equipment management
• patient centred facilities

4. Continuous Medical Education – CME
practical skills versus academic training
• Case based training
• Skills and team orientation
• Regional exchange - Peer
reviews
• Supervision- learning from
mistakes
• skill labs
• eLearning
• Conferences and live
streams
• Exchange with
neighbouring countries
• Information Repositories

5. Integration of new evidence into care
• Evidence from
international trials and
epidemiologic studies -
EBM
• Clinical Practice
Guidelines – CPG
• Institutional protocols
• International expertise
• Training on CPGs

6. Putting the Patient/client into the centre
of attention
• Pregnancy diary
• Information brochure
• Low birth weight brochure
• Mother’s/parent’s training

7. Information for change and management
• Equipment information system
• patient registry
• perinatal repository (website)
• Targeted changes versus broad
investment- mortality audits -
babies matrix

8. Governance
• management training
• Decentralisation
(facility, rayon, oblast)
• Supporting
professional
associations,
• National, regional and
international
networking
• summer school

9. Outlook
• towards a team oriented working culture
• Developing a culture of openly dealing with mistakes -
mortality audits - near miss cases – supervision
• Orientation towards Patient/client and staff needs
• Continuously integrating new knowledge - CPGs
• networking, knowledge sharing
• Incentive setting for efficiency gains
• Governance – strengthening institutions at all levels -
National health reform strategy 2015-20

10. Outlook
• towards a team oriented working culture
• Developing a culture of openly dealing with mistakes -
mortality audits - near miss cases – supervision
• Orientation towards Patient/client and staff needs
• Continuously integrating new knowledge - CPGs
• networking, knowledge sharing
• Incentive setting for efficiency gains
• Governance – strengthening institutions at all levels -
National health reform strategy 2015-20