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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

Ebonyi stateRegina kamogaKennedy abiahuAnthony adoghePeter baffoeBoniface onweOlumuyiwa ojoJuan francoEmma veitchJennifer rasanathanKathleen hillSalma anasEbonyi state ministry of healthMinistry of healthMelinda gates foundationWorld health organization