From Protocol to Practice: Implementing WHO Quality-of-Care Standards for maternal and newborn care in selected Zambian Health Facilities - Lessons learnt from the Journey towards Centers of Excellence

Abstract

Background: Maternal and newborn mortality remain a challenge in Zambia, particularly during the antepartum, intrapartum, and neonatal periods. To address these gaps and improve outcomes, the Ministry of Health (MoH) implemented standardized Maternal and Newborn Health (MNH) and Small and Sick Newborns (SSN) quality of care (QoC) standards to improve health outcomes and generate evidence to inform national scale-up. We set out to document the best practices and lessons learned from this collaborative initiative.
Methods: In 2024, MNH and SSN WHO QoC standards were rolled out in the eight selected health facilities using a phased approach. Twenty-one MNH QoC indicators were integrated into HMIS via DHIS2, supported by digital tools. Standard Operating Procedures and assessment tools were developed through stakeholder consultations. Capacity-building workshops and targeted mentorship supported implementation. Baseline, midline and end line assessments were conducted using health facility assessments and a qualitative case design to identify best practices and challenges.
Results: Key achievements included integrating MoH-approved indicators into HMIS, adopting digital checklists, strengthening mentorship, and improving quality-of-care standards. From baseline to endline, maternal and newborn care scores increased for Standard 2 (use of health information data) by 14%
(percentage change: 34.3%) and 13.5 percent-points (percentage change 32.7%) respectively. Similarly, under the small and sick newborn (SSN) guidelines, Standard 2 improved by 24.5% (percentage change: 49%), while Standard 3 improved by 21.1% (percentage change: 36.1%). Implementation was constrained by factors such as limited skilled personnel, deficiencies in respectful care, infrastructure gaps, and supply shortages. Nonetheless, several best practices were identified, including engagement of leadership and stakeholders, promotion of peer mentorship, and embedding QoC within existing health system structures.
Conclusions: The initiative demonstrates that integrating standardized QoC practices within existing health systems can significantly improve maternal and newborn outcomes. Sustaining and scaling these gains will require addressing resource gaps and strengthening data use for decision-making.