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

Table 5 Factors influencing efficacy of QI measures

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]

ISSN: 1748-5908