A clear guide to improving care of mothers and babies in low-resource settings

By: Tamar Chitashvili, Silvia Holschneider, Jorge Hermida, and Nigel Livesley 

There is growing recognition that clinical training and health infrastructure — while essential—are insufficient for improving and sustaining life-saving maternal and newborn health care services in low-resource settings. Instead, broader systems strengthening and continuous quality improvement efforts at the service delivery level are needed to continuously assess gaps in processes and content of care and to plan, test, implement, regularly monitor, refine and institute changes to deliver services correctly and consistently. To respond to this need and help frontline care providers in their continuous quality improvement journey, “Improving Care for Mothers and Babies: A Guide for Improvement Teams” was recently developed through collaborative efforts of the Survive & Thrive Global Development Alliance (S&T GDA).

Many health care providers are confused by various quality improvement concepts and jargon. Without availability of clear and simple guidance on how to actually implement improvement efforts in their facilities, they consider it complicated and costly.

The purpose of the guide “Improving Care for Mothers and Babies” is to demystify the quality improvement process for those who are new to it, or need additional practice. 

The guide provides step-by-step instructions to care providers and improvement teams to plan, test, implement, continuously assess, refine and sustain interventions to keep mothers and babies healthy. Users learn how to implement what we know works — high impact evidence-based interventions — reliably, in different contexts, every time, for every patient who needs them. The guide can be used by a leader or facilitator to help others learn about and practice improvement both in clinical and workshop settings. It may also be used as a self-study manual by improvement teams.

But handing health providers a guide to improve care may not be enough. While the guide and its sections have been introduced and field tested at workshops in several countries — and reviewed by a large group of experts and key global, regional and national stakeholders — what is not known yet is how effective it will be in initiating and establishing continuous improvement processes in health care facilities and in improving maternal and newborn care and its outcomes.

ASSIST is planning a study to identify the most effective and cost-effective strategy to implement the guide. Specifically, the study will look at comparative effectiveness and cost-effectiveness of three different implementation scenarios in terms of their ability to initiate and sustain continuous improvement processes in health care settings and improve maternal and newborn care processes and outcomes at the lowest cost. These alternative implementation strategies are as follows:

  1. The guide alone is provided to care providers;

  2. The guide and an orientation workshop for several facility improvement teams is provided; and

  3. The guide is provided together with coaching support to facility QI teams through one improvement cycle (Plan-Do-Study-Act cycle).

Will this QI guide and its evaluation answer the burning question on how to initiate and scale up quality improvement practices globally without substantial financial resources and external support? The answer yet is unknown, but—given the potential reach of the Survive and Thrive Global Development Alliance network* and usefulness of this new guide—the early field test results are very encouraging.

*From 2010–2014, partners of the Helping Babies Breathe Global Development Alliance, the predecessor of Survive and Thrive Global Development Alliance, trained more than 293,000 health care providers in 75 different countries.


The guide provides objectives, key knowledge, practice exercises, and group discussions to lead the user through learning, practice, and action. Two versions of the guide are available, as well as a version in French.

Developed for Africa For use in Africa In French


“Improving Care for Mothers and Babies” was conceived and designed by the Survive and Thrive Global Development Alliance. The small authors group working on it consisted primarily of the American Academy of Pediatrics and ASSIST. From the ASSIST team Jorge Hermida served as the Associate Editor for the publication; and Tamar Chitashvili and Nigel Livesley were on the editorial board.

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