Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

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A number of quality improvement processes for obstetric care in low- and middle-income countries (LMICs) are amenable to change at limited or no additional cost, although some identified barriers may be difficult to address without increased resources.

Maternal mortality remains a major international health problem in LMICs, and most could have been prevented by quality improvement interventions already demonstrated to be effective, such as clinical guideline implementation strategies. This systematic review synthesised qualitative evidence on guideline implementation strategies to improve obstetric care practice in LMICs in order to identify barriers and enablers to their successful implementation. Pathways to implementation may be complex and require further research to develop our understanding of individual and organisational behaviours and motivation in LMIC settings.

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