Background: Clinical governance (CG) is necessary for promoting quality, accessible healthcare and a sustainable health system. While many high-income countries have adopted integrated system-wide CG approaches, many low- and middle-income countries (LMICs) have not implemented unified CG systems.

Objectives: We examine efforts towards improving CG in LMICs, asking: What strategies are being used to strengthen CG in LMICs and what opportunities and challenges arise in instituting and sustaining CG?

Methods: Our search strategy sought to identify peer-reviewed literature on implementation and experiences of CG at district-, regional- and national-levels in LMICs. Using PUBMED, Global Health and SCOPUS databases, we selected materials published from 2000 (when the World Health Organization renewed its vision for system-led quality improvement) to 2016. Based on inclusion criteria, titles and abstracts, and full texts are being screened independently by two team members. We have developed a conceptual framework for data charting and synthesis around five emerging dimensions: (i) CG - policy or framework, (ii) systems, (iii) institutions or agents of change, (iv) resources, and (v) methods of evaluation.

Results: Our initial search output (sans duplicates) generated 4781 papers, which reduced to under 500 following first-stage exclusion of disease-specific, single facility and within-project CG. As we move towards screening completion, we estimate that approximately 60 full text papers will be extracted for analysis and synthesis. Preliminary review of full text papers suggests that many LMICs are moving towards adopting integrated CG systems. Projects and agendas of external institutions/bodies are driving many LMICs’ national quality improvement priorities. Strategies for strengthening CG are dominated by human resource capacity building interventions, over technologies, accreditations, integrated policy frameworks and regular evaluation of existing CG systems. Final results will be presented at the conference.

Conclusions: This review will map the progress of LMIC towards establishing and strengthening clinical governance systems.