Barriers to conducting effective obstetric audit in Ifakara: a qualitative assessment in an under‐resourced setting in Tanzania

Abstract

Abstractobjective To explore barriers to and solutions for effective implementation of obstetric audit at Saint Francis Designated District Hospital in Ifakara, Tanzania, where audit results have been disappointing 2 years after its introduction.methods Qualitative study involving participative observation of audit sessions, followed by 23 indepth interviews with health workers and managers. Knowledge and perceptions of audit were assessed and suggestions for improvement of the audit process explored.results During the observational period, audit sessions were held irregularly and only when the head of department of obstetrics and gynaecology was available. Cases with evident substandard care factors were audited. In-depth interviews revealed inadequate knowledge of the purpose of audit, despite the fact that participants regarded obstetric audit as a potentially useful tool. Insufficient staff commitment, managerial support and human and material resources were mentioned as reasons for weak involvement of health workers and poor implementation of recommendations resulting from audit. Suggestions for improvement included enhancing feedback to all staff and managers to attend sessions and assist with the effectuation of audit recommendations.

Strengths and weaknesses in the implementation of maternal and perinatal death reviews in Tanzania: perceptions, processes and practice

“…; van Hamersveld et al . ), attrition of staff (Nyamtema et al . ) and inadequate identification of sub‐standard care (Kidanto et al .…”

“…; van Hamersveld et al . ). The overall aim of this study was to explore the current implementation of MPDRs in Tanzania.…”

Easier said than done!: methodological challenges with conducting maternal death review research in Malawi

“…The issue of recommendations lies in the question of whether the recommendations will be acted upon and subsequently evaluated. Previous studies have shown that recommendations resulting from the audit sessions were poorly implemented because of a lack of human and material resources and insufficient staff and senior management commitment [13,14]. Conversely, in other studies where recommendations were implemented and evaluated, reductions in maternal mortality, the case fatality rate [50,51], the incidence of uterine rupture, obstetric hemorrhage and the number of women with severe maternal complications were observed [52,53].…”

“…More recently, van Hamersveld and colleagues [14] explored barriers to implementing an obstetric audit at Saint Francis Designated District Hospital in Ifakara, Tanzania. They conducted participant observations and in-depth interviews with 23 healthcare workers who reported that audit sessions were only convened when the head of the department of obstetrics and gynecology was available.…”

“…They also stated that insufficient staff commitment, managerial support and resources all contributed to poor implementation of recommendations that resulted from the audit session. Moreover, van Hamersveld and colleagues observed that participants had inadequate knowledge of the purpose of the audits [14]. These studies focused on the entirety of the maternal death review process, with a heavy emphasis on establishing a committee and implementing the recommendations.…”