Improving quality across the continuum of care

Improving poor maternal and newborn outcomes relies upon improving available care in low and middle-income settings. The continuum of care (CoC) coverage cascade is a novel method which makes efficient use of existing data while incorporating new data, such as content of care measures, as possible. The CoC cascade not only measures who is getting quality care but also shows the magnitude of coverage gaps and where the biggest missed opportunities are occurring for women and newborns along the entire cascade. This study demonstrates the method using data from 13 countries: Bangladesh, Burkina Faso, Cambodia, Côte d'Ivoire, Ghana, Jordan, Kenya, Lesotho, Mozambique, Nepal, Philippines, Senegal, and Tanzania.

In Tanzania, neonatal deaths remain high. While NEST360 has supported hospitals with equipment, training, and data tools, outcomes still vary. This study focused on understanding what high-performing hospitals are doing differently. We analyzed NEST360 data from 2022-2024 and conducted 26 interviews with neonatal staff in four top-performing facilities. Key strategies included targeted capacity building, strong quality improvement teams, improved staffing, and consistent data use through a dashboard. Our facilities also used simple but effective thermal care, such as KMC carriers and hot bottles. Common challenges included inadequate space like bath areas for mothers, limited oxygen and electricity. Some facilities developed local solutions like 'dashboard days' and weekend technical support. Our findings show that while many strategies are scalable, national support is needed to address persistent system gaps. Strengthening infrastructure, updating guidelines, and improving funding transparency are essential for equitable newborn care.