Figure 1.

Facility level improvement—the quality and safety cube. In many LMIC the quality, safety and thus outcomes of facility-based care are undermined by challenges in three core resource areas, inadequate physical or material resources, deficits in workforce capacity and capability, and poor team and organisational relationships. As a result, local facilities operate within the red zone of the cube. Effective interventions that address one or two resource issues may result in unidimensional or bidimensional improvements. However, in weak systems, all three areas need strengthening. Addressing resource inadequacies typically needs to be accompanied by efforts to create and align motive forces if the system status quo is to be changed. Learning across the system and recognising progress can help address unanticipated challenges or consequences and build momentum. (LMIC, low-income and middle-income country).