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n was unable to achieve the substantial changes required to provide a comprehensive package of services to all mothers and children. We suggest the QI process be adapted to complex under-resourced health systems, building on the strengths of this approach, to provide workable health systems strengthening solutions for scalable implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04278612. Date of Registration February 19, 2020. Retrospectively registered.BACKGROUND It is generally assumed that there have been mixed results in the lit
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