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Table 5 Factors influencing efficacy of QI measures

From: Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review

Local level Studies Systems level Studies
Promoters
 Motivation of key individuals 3 studies—[35, 42, 51] Relationships between health workers, community leaders and district officials 1 study—[42]
 Continuous monitoring throughout 2 studies—[38, 56] High-quality national data collection 1 study—[60]
 Interdisciplinary collaboration 2 studies—[35, 38] Formal health service support 1 study—[35]
 Abandonment of unnecessary practices 1 study—[36] NGO collaboration initiatives 1 study—[58]
 Schemes tailored to participants 1 study—[38]  
 On-site support 1 study—[44]
 Refresher programmes 1 study—[44]
 Formal training in QI methods 1 study—[35]
 Low cost of intervention 1 study—[38]
Barriers
 Overburdened staff 4 studies—[36, 42, 53, 56] Insufficient funding 1 study—[42]
 Lack of sufficient equipment 4 studies—[36, 38, 42, 58] Insufficient health services relative to demand 1 study—[42]
 High changeover of workforce 3 studies—[35, 36, 53] Government redistribution of staff 1 study—[53]
 Defects in staff knowledge and practice 1 study—[35] Inadequate documentation 1 study—[39]
 Unmotivated staff 1 study—[53] Confounding health policy changes 1 study—[50]
 Multiple QI measures/audits simultaneously 1 study—[55]  
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