Table 5

Key recommendations for effective NMCR implementation

Short termLong term
External partners
  • Ensure technical support.

External partners
  • Ensure sustained technical support, in particular on the quality of the NMCR.

National level
  • Ensure general commitment and understanding of national and local health authorities.

  • Ensure financial resources.

  • Make available updated evidenced-based national guidelines and standards.

  • Develop a good action plan and budget, covering all WHO recommendations.*

  • Create the legal framework.

  • Ensure effective leadership and coordination.

  • Ensure timely monitoring and evaluation.

  • Support timely transparent results dissemination to health staff and the community.

  • Promote local responsibility and ownership.

  • Collaborate with an external body for quality assessment.

National level
  • Integrate NMCR in a comprehensive quality improvement plan for maternal and newborn health.

  • Support continuous medical education.

  • Integrate key concepts of quality improvement methods, including audits, in medical and midwifery schools’ curricula.

  • Support and disseminate a culture that promotes health system changes, professionalism and team work.

  • Training in communication skills and team management.

  • Policies to ensure adequate resources (human resources, equipment and supplies) to health facilities.

  • Policies to improve quality of documentation.

  • Community empowerment and policies for including service users views in health planning.

Local level
  • Ensure commitment, understanding and active participation of hospital directors.

  • Dissemination of updated evidenced-based national guidelines and standards.

  • Develop a good action plan and budget, covering all WHO recommendations,5 considering feasibility based on local resources.

  • Inform and create awareness among all staff.

  • Train and adequate number and type of staff.

  • Consider ways to provide some form of professional recognition for health staff involved in NMCR.

  • Ensure effective leadership and coordination.

  • Ensure that NMCR sessions are carried forward according the WHO recommendations.5

  • Ensure that recommendations from the NMCR are put in place.

  • Ensure timely transparent results dissemination to all staff.

Local level
  • Same activities as for national level, when appropriate to local level.