Minara Chowdhury and colleagues reflect on workforce motivation for quality improvement projects in maternal and newborn healthcare in Bangladesh
Standards for delivering quality maternal, newborn, and child care, such as those from the World Health Organization, emphasise the importance of a competent, motivated workforce.1 Given that the emotional state of health workers and burnout affects their motivation for quality improvement, meeting these standards requires influencing the health system environment.2 We argue from evidence and our experience from healthcare improvement that working to gain greater understanding of what motivates a workforce will help health systems develop improved services. Aligned with this, the American business theorist W Edwards Deming asserted that, to transform quality culture, every employee should be able to achieve joy at work and that joy would lead to improved quality and a high performing organisation.3
Limited resources and space, excessive de
Ugo Okoli and colleagues argue that much can be learnt from Nigeria’s efforts to strengthen continuous measurement of quality using routine data sources to help improve quality of care for women and children
Continuous measurement is a core principle of improving quality of care.12 However, routine data on quality are often limited in resource constrained settings. In many such settings, the primary sources of information on quality of care are periodic assessments often household surveys and healthcare facility assessments. Such assessments, however, are usually too infrequent to be useful for improving care and are often driven by external agencies and donors rather than by local bodies. For example, in Kenya surveys of service provision from 2004 and 2010 showed that respiratory rate was evaluated in 24% and 25% of observed encounters with sick children, respectively.34 For healthcare workers trying to improve care for sick children, an assessment every 5-10 years has limited val
An approach to consistently deliver quality healthcare to everyone, everywhere
Quality healthcare is fundamental to the right to health and its delivery at all times.1 People are healthier and are living longer than ever before, but poor quality care is still causing preventable deaths and unacceptable inequities, especially in low and middle income countries. Despite widespread recognition of the importance of quality health services, improvement efforts continue to struggle against persistent gaps in financing, workforce, and healthcare infrastructure, alongside the overlapping global challenges from pandemics, conflicts, and climate change.23 As the covid-19 pandemic showed, quality matters even more for population health during a crisis.4
Health systems in low and middle income countries operate in different contexts and possess different capacities. Despite these differences, quality care can be sustained and scaled up if it is championed by consistent leadership and supported b
Michael Peters and colleagues argue that concerted efforts to embed implementation research can improve health services, even in the most challenging operating environments
As countries emerge from the acute phase of the SARS-CoV-2 (covid-19) pandemic, there is a need to reflect on global systems of knowledge production and uptake. The rapidly evolving context of the covid-19 pandemic response demanded timely interpretation and translation of evidence into policy and action to reduce morbidity and mortality, yet existing systems were largely unable to keep up with demand.1 Decision making informed by health services research was essential during this time of flux but is also important for continuous improvement of quality healthcare delivery. Before 2020, poor quality healthcare contributed to more lives lost in low and middle income countries (LMICs) than lack of access to health services.2 The size of the gap between the care patients should receive and the care patients actually re
Tarini Shankar Ghosh and Ana Maria Valdes evaluate the evidence for clinical effects of microbiome altering interventions on cardiometabolic traits
### Key messages
Cardiometabolic diseases are one of the main causes of morbidity and mortality in western countries and are increasing in low and middle income countries.1 Dietary intake is one of the main determinants of cardiometabolic health1 and of microbiome composition.2 The gut microbiome is known to play an important part in the development of cardiometabolic diseases, including hypertension, diabetes, and obesity.2 This is thought to be linked with the ability of the gut microbiome to modulate inflammation, insulin sensitivity, and blood lipid levels, and is hypothesised to be mediated by specific microbially produced metabolites such as short chain fatty acids (SCFAs), secondary bile acids, phenylacetylglutamine, and trimethylamine-N-oxide.2
As well as their direct influence, gut microbes can also modulate the response of the