The Quality Care Network (QCN) was conceptualized by the World Health Organisation (WHO) and other global partners to facilitate learning on and improve quality of care for maternal and newborn health within and across low and middle-income countries. However, there was significant variance in the speed and extent in which QCN formed in the involved countries. This paper investigates the factors that shaped QCN’s differential emergence in Bangladesh, Ethiopia, Malawi, and Uganda. Drawing on network scholarship, we conducted a replicated case study of the four country cases and triangulated several sources of data, including a document review, observations of national-level and district level meetings, and key informant interviews in each country and at the global level. Thematic coding was performed in NVivo 12. We find that QCN emerged most quickly and robustly in Bangladesh, followed by Ethiopia, then Uganda, and slowest and with least institutionalization in Malawi. Factors connected to the policy environment and network features explained variance in network emergence. With respect to the policy environment, pre-existing resources and initiatives dedicated to maternal and newborn health (MNH) and quality improvement, strong data and health system capacity, and national commitment to advancing on synergistic goals were crucial drivers to QCN’s emergence. With respect to the features of the network itself, the embedding of QCN leadership in powerful agencies with pre-existing coordination structures and trusting relationships with key stakeholders, inclusive network membership, and effective individual national and local leadership were also crucial in explaining QCN’s speed and quality of emergence across countries. Studying QCN emergence provides critical insights as to why some well-intentioned top-down global health networks don’t materialize in some country contexts and have relatively quick uptake in others, and has implications for a network’s perceived legitimacy and ultimate effectiveness in producing stated objectives.

The authors have declared no competing interest.

This work was funded by the Medical Research Council (MRC) Health System Research Initiative 5th call via grant MR/S013466/1 to TC at UCL Institute for Global Health, United Kingdom, YRS and JS at Johns Hopkins University, United States of America, KA and AK at Diabetic Association of Bangladesh Perinatal Care Project, Bangladesh, CM at Parent and Child Health Initiative, Malawi, GS at Makerere University School of Public Health, Uganda, and ME at University of Oxford, United Kingdom and by the Bill & Melinda Gates foundation via grant INV-007644 to TM at LSHTM, United Kingdom. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Ethical approval was received from University College London Research Ethics Committee (ref: 3433/003) BADAS Ethical Review Committee (ref: BADAS-ERC/EC/19/00274), Ethiopian Public Health Institute Institutional Review Board (ref: EPHI-IRB-240-2020), National Health Sciences Research Committee in Malawi (ref: 19/03/2264) and Makerere University Institutional Review Board (ref: Protocol 869).

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All data is derived from qualitative interviews, most with stakeholders where only one individual holds a position, either within federal or state government, facilities, or NGOs. Every care has been taken to ensure anonymity of the data in the submitted manuscript but the authors from all 4 countries feel strongly that making data freely available would jeopardise the conditions of informed consent. We therefore request to be exempt from the requirement to make data available but have uploaded a detailed methods document (S2_Text). Thank you for your consideration.