Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers’ perspective

Abstract

ObjectiveTo describe health workers’ perceptions of a quality improvement (QI) intervention that focused on improving institutional childbirth services in primary health facilities in Southern Tanzania.DesignA qualitative design was applied using in-depth interviews with health workers.SettingThis study involved the Ruangwa District Reproductive and Child Health Department, 11 dispensaries and 2 health centres in rural Southern Tanzania.Participants4 clinical officers, 5 nurses and 6 medical attendants from different health facilities were interviewed.ResultsThe healthcare providers reported that the QI intervention improved their skills, capacity and confidence in providing counselling and use of a partograph during labour. The face-to-face QI workshops, used as a platform to refresh their knowledge on maternal and newborn health and QI methods, facilitated peer learning, networking and standardisation of care provision. The onsite follow-up visits were favoured by healthcare providers because they gave the opportunity to get immediate help, learn how to perform tasks in practice and be reminded of what they had learnt. Implementation of parallel interventions focusing on similar indicators was mentioned as a challenge that led to duplication of work in terms of data collection and reporting. District supervisors involved in the intervention showed interest in taking over the implementation; however, funding remained a major obstacle.ConclusionsHealthcare workers highlighted the usefulness of applying a QI approach to improve maternal and newborn health in rural settings. QI programmes need careful coordination at district level in order to reduce duplication of work.

Health workers' experiences of collaborative quality improvement for maternal and newborn care in rural Tanzanian health facilities: A process evaluation using the integrated 'Promoting Action on Research Implementation in Health Services' framework

“…Their perceptions suggest subordinate importance of these meetings compared to the mentoring and coaching visits to their facilities. This was also found in the study on health worker perspectives of QI in the same area of Tanzania mentioned above, and similarly from high-income settings [18, 49].…”

“…Contrary to run-charts, there was a wide range of understanding and reported use of PDSA-cycles, also found in a recent study investigating health worker perspectives of a QI intervention for institutional childbirth care in the same area of Tanzania [18]. In our study, health workers would only mention PDSA-cycles when prompted, suggesting that this intervention component was of subordinate importance to them.…”

Improving Tanzanian childbirth service quality

“…During our study, medical attendants were actively involved without considering their educational level. This created a positive impact on their performance, but led to delays in understanding some technical issues; for example, most were learning how to complete partographs for the first time ( Jaribu et al , 2016 ).…”

The Three-Gap Model of Health Worker Performance

“…A primary symptom of this poor quality is low adherence to medical protocols [1,2,3,4,5,6,7,8,9,10,11]. Given the significant evidence that increases in protocol adherence are one of the most effective ways to improve outcomes and prevent childhood deaths [12,13,14,15], a continued focus on process quality seems appropriate.…”