Raising a mirror to quality of care in Tanzania: the five-star assessment

Yahya, Talhiya; Mohamed, Mohamed

doi:10.1016/s2214-109x(18)30348-6

Cited by 43 publications

(67 citation statements)

References 10 publications

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“…Quality assessment tools found in literature either look at overall quality of care or focus on more specific services (for example on HIV/AIDS). Some tools primarily aim to systematically evaluate service quality with the purpose of providing evidence for national policy, planning or management decisions, or for accreditation and licensing [13–20]. When examining overall quality of care, such assessment tools tend to be lengthy, time-consuming and technically demanding [13].…”

Section: Introductionmentioning

confidence: 99%

Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare

Renggli

Mayumana

Mboya

et al. 2019

BMC Health Serv Res

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BackgroundProgress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyzed an electronic tool, which was developed to assess and monitor the quality of primary healthcare in Tanzania in the context of routine supportive supervision. The electronic assessment tool focused on areas in which improvements are most effective in order to suit its purpose of routinely steering improvement measures at local level.MethodsDue to the lack of standards regarding how to best measure quality of care, we used a range of different quantitative and qualitative methods to investigate the appropriateness of the quality assessment tool. The quantitative methods included descriptive statistics, linear regression models, and factor analysis; the qualitative methods in-depth interviews and observations.ResultsQuantitative and qualitative results were overlapping and consistent. Robustness checks confirmed the tool’s ability to assign scores to health facilities and revealed the usefulness of grouping indicators into different quality dimensions. Focusing the quality assessment on processes and structural adequacy of healthcare was an appropriate approach for the assessment’s intended purpose, and a unique key feature of the electronic assessment tool. The findings underpinned the accuracy of the assessment tool to measure and monitor quality of primary healthcare for the purpose of routinely steering improvement measures at local level. This was true for different level and owner categories of primary healthcare facilities in Tanzania.ConclusionThe electronic assessment tool demonstrated a feasible option for routine quality measures of primary healthcare in Tanzania. The findings, combined with the more operational results of companion papers, created a solid foundation for an approach that could lastingly improve services for patients attending primary healthcare. However, the results also revealed that the use of the electronic assessment tool outside its intended purpose, for example for performance-based payment schemes, accreditation and other systematic evaluations of healthcare quality, should be considered carefully because of the risk of bias, adverse effects and corruption.

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Section: Introductionmentioning

confidence: 99%

Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare

Renggli

Mayumana

Mboya

et al. 2019

BMC Health Serv Res

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“…1 , www.dhsprogram.com ) [ 10 ]. Women often choose to deliver at home with a traditional birth attendant (TBA) or a family member who observes progress and facilitates the delivery [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In Tanzania this proportion was only 3 medical professionals per 10.000 in 2010 [ 24 ]. Tanzania has no legal structure that regulates the registration of public health facilities, so there are no official minimum national standards on quality of care [ 16 ]. A five star-rating system was established in 2015 to gather information about the problems around access to and referral between health facilities.…”

Section: Introductionmentioning

confidence: 99%

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The influence of quality and respectful care on the uptake of skilled birth attendance in Tanzania

Hulsbergen

Kwaak

2020

BMC Pregnancy Childbirth

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Background An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate. Methods This narrative review employed the “person-centered care framework for reproductive health equity” as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included. Results Uptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels. Conclusions To further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.

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“…In fact, the lack of electrification leaves many primary healthcare facilities in LMIC with inadequate power provision for even basic services [5,6]. Likewise, assessment of infrastructure in public health facilities in LMIC reveals inadequate space and physical facilities for even essential service provisions with a large proportion of facilities requiring urgent major renovation or complete reconstruction [7,8].…”

Section: Introductionmentioning

confidence: 99%

Reliable energy and responsive built environment: the missing links in COVID-19 response in resource-limited settings

Rinkoo¹,

Songara²,

Sharma³

et al. 2020

Trop Med Health

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Irrespective of how the COVID-19 pandemic evolves over time across the globe, our past experiences with comparable zoonotic diseases demonstrate the significance of having resilient primary healthcare systems to successfully respond to public health emergencies. However, literature corroborates that in low-and middle-income countries, the primary healthcare systems are plagued with significant energy insecurity and inadequate built environment. These gaps in reliable energy and responsive built environment in primary healthcare systems are exacerbated during disruptive public health emergencies such as COVID-19. In this letter, we discuss the way forward to address these gaps and the policy and practical implications thereof.

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Raising a mirror to quality of care in Tanzania: the five-star assessment

Abstract: for shifting the culture of care towards one of datadriven quality improvement. Finally, sharing data across health systems created opportunities for system-wide improvements that we believe will move Tanzania closer to delivering truly high-quality care to all its citizens.

Cited by 43 publications

References 10 publications

Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare

Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare

The influence of quality and respectful care on the uptake of skilled birth attendance in Tanzania

Reliable energy and responsive built environment: the missing links in COVID-19 response in resource-limited settings

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