Sustaining Quality of Care program in maternal and neonatal health: Key enablers and barriers in Malawi's primary health facilities- A qualitative study

Background Improving the quality of care in primary health facilities is a central concern in global health. While substantial investments have been made in quality improvement initiatives, their long-term sustainability remains uncertain, particularly in low- and middle-income countries. Despite significant efforts, challenges persist in maintaining the effectiveness of these programs over time. This study aimed to explore the key enablers and barriers to the sustainability of quality of care programs in maternal and neonatal healthcare in Malawian primary health facilities, particularly Mdeka and Chilomoni in the Blantyre District. Study design: This study employed a qualitative research approach with a cross-sectional descriptive design. Data were collected via in-depth interviews and focus group discussions from a purposive sample of 27 participants, including five policymakers, twelve health workers, and ten clients at the Mdeka and Chilomoni health facilities. The data were analysed via thematic analysis to identify key patterns and themes. Results The analysis of the data revealed four major themes influencing the sustainability of quality of care program at Mdeka and Chilomoni health facilities. These were shaped by the availability of resources, leadership practices, human capacity, motivation, and community engagement. The themes reflected both enabling and constraining factors, as perceived by the participants. Conclusion The sustainability of quality of care programs in primary health facilities in Malawi is influenced by multiple interrelated factors. Addressing gaps in these domains is essential for embedding quality improvement into routine service delivery and safeguarding long-term maternal and neonatal health gains. Strengthening leadership accountability, embedding capacity building, and institutionalising community participation is critical to sustaining quality improvement initiatives and improving maternal and neonatal outcomes.