National learning systems to sustain and scale up delivery of quality healthcare: a conceptual framework.

All around the world, health systems fail to provide good quality of care (QoC). By developing learning systems, health systems are able to better identify good practices and to explain how to sustain and scale these good practices. To facilitate the operationalisation of national learning systems, the Network for Improving Quality of Care for Maternal Newborn and Child Health (the Network) developed a conceptual framework for national learning systems to support QoC at scale. The Network facilitated an iterative process to reach consensus on a conceptual framework for national learning systems to sustain and scale up delivery of quality healthcare. Following a landscape analysis, the Network Secretariat and WHO convened two consultative meetings with country partners, technical experts and stakeholders. Based on these inputs, we developed a conceptual framework for national learning systems to support QoC at scale. National learning systems use a variety of approaches to identify practices that have improved QoC at the patient and provider levels. They also facilitate scale up and sustain strategies used successfully to support quality improvement. Despite growing consensus on the importance of learning for QoC, no one has yet detailed how this learning should be operationalised nationally. Our conceptual framework is the first to facilitate the operationalisation of national learning systems so that health systems can begin to develop, adapt and implement mechanisms to learn about what works or fails and to scale up and sustain this learning for QoC.

Maternal, newborn, child and adolescent health: challenges for the next decade.

The Millennium Development Goals era achieved substantial improvements in the health of women and children. Yet progress was uneven and many women and children still suffer from preventable mortality and morbidity. The United Nations Secretary General's Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) set out an ambitious 'survive, thrive and transform' agenda for countries as they accelerate progress towards the health-related Sustainable Development Goals. This review highlights aspects of 'survive, thrive and transform' that have had strong traction globally, namely quality of care and humanitarian settings for 'survive', early childhood development and adolescent health for 'thrive' and community engagement and a sustainable environment for 'transform'.

Perinatal mortality in non-western migrants in Norway as compared to their countries of birth and to Norwegian women.

BACKGROUND: A large number of women from countries with a high perinatal mortality rate (PMR) settle in countries with a low PMR. We compared the PMRs for migrants in Norway with the PMRs in their countries of birth. We also assessed the risk of perinatal death in offspring of migrant women as compared to offspring of Norwegian women. METHODS: The Medical Birth Registry of Norway and the Norwegian Central Person Registry provided data on births in Norway during the years 1986 to 2005 among all women born in Norway, Pakistan, Vietnam, Somalia, Sri Lanka, Philippines, Iraq, Thailand and Afghanistan. Information on the PMRs in the countries of birth was obtained from the World Health Organisation (WHO) for the years 1995, 2000 and 2004. Mean PMRs in Norway during 1986-2005 were calculated by mother's country of birth, and the risks of perinatal death by country of birth were estimated as odds ratios (OR) using Norwegian women as the reference. Adjustments were made for mother's age, plurality, parity, year of birth and gestational age at birth. RESULTS: The PMRs for migrants in Norway were lower than in their countries of birth. The largest difference was in Afghan women (97 deaths per 1000 births in Afghanistan versus 24 deaths per 1000 births in Afghan women in Norway), followed by Iraqi and Somali women. As compared with Norwegian women, the adjusted odds ratio (OR) of perinatal death was highest for Afghan (OR 4.01 CI: 2.40 - 6.71), Somali (OR 1.83 CI: 1.44 - 2.34) and Sri Lankan (OR 1.76 CI: 1.36 - 2.27) women. CONCLUSIONS: The lower PMRs for migrants in Norway as compared to the PMRs in their countries of birth may be explained by access to better health care after migration. The increased risk of perinatal death in migrants as compared to Norwegians encourages further research.