Towards improved health service quality in Tanzania: An approach to increase efficiency and effectiveness of routine supportive supervision

Abstract

Effective supportive supervision of healthcare services is crucial for improving and maintaining quality of care. However, this process can be challenging in an environment with chronic shortage of qualified human resources, overburdened healthcare providers, multiple roles of district managers, weak supply chains, high donor fragmentation and inefficient allocation of limited financial resources. Operating in this environment, we systematically evaluated an approach developed in Tanzania to strengthen the implementation of routine supportive supervision of primary healthcare providers. The approach included a systematic quality assessment at health facilities using an electronic tool and subsequent result dissemination at council level. Mixed methods were used to compare the new supportive supervision approach with routine supportive supervision. Qualitative data was collected through in-depth interviews in three councils. Observational data and informal communication as well as secondary data complemented the data set. Additionally, an economic costing analysis was carried out in the same councils. Compared to routine supportive supervision, the new approach increased healthcare providers’ knowledge and skills, as well as quality of data collected and acceptance of supportive supervision amongst stakeholders involved. It also ensured better availability of evidence for follow-up actions, including budgeting and planning, and higher stakeholder motivation and ownership of subsequent quality improvement measures. The new approach reduced time and cost spent during supportive supervision. This increased feasibility of supportive supervision and hence the likelihood of its implementation. Thus, the results presented together with previous findings suggested that if used as the standard approach for routine supportive supervision the new approach offers a suitable option to make supportive supervision more efficient and effective and therewith more sustainable. Moreover, the new approach also provides informed guidance to overcome several problems of supportive supervision and healthcare quality assessments in low- and middle income countries.

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

“…These two points will however be investigated in a subsequent paper [35]. The study did additionally not demonstrate how the approach was able to increase more generally the feasibility of routine supportive supervision, but this was shown elsewhere [36]. Finally, none of the studies examined the effects of the e-TIQH assessment tool or improvements in quality of care on changes in health outcomes.…”

“…Overall, the results presented here together with previously reported findings [34] strongly suggested that the e-TIQH assessment tool, which focused on processes and structural adequacy of healthcare, is accurate enough to assess and monitor quality of primary healthcare for the purpose of routinely steering improvement measures. In practice, its ability to measure quality of care over time reflected a feasible approach to be used during supportive supervision and received great support from the CHMTs and health facilities staff [36]. However, the value of the e-TIQH assessment tool would need to be carefully reassessed if it were to be used outside its intended purpose.…”

“…Morogoro Region: (1) Kilosa DC (later split into Kilosa and Gairo DC), (2) Mvomero DC, (3) Morogoro DC, (4) Kilombero DC, (5) Ulanga DC; Pwani Region: (6) Bagamoyo DC, (7) Rufiji DC; Iringa Region: (8) Iringa MC. Asterisks mark councils selected for qualitative data collection (figure previously published in [36])…”

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Fig. 2Chart of the three-stage process of the e-TIQH supportive supervision approach (figure previously published in [36])

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“…Given the lack of a gold standard regarding how to best measure quality of care, we tried to verify the validity of the e-TIQH assessment tool by using a range of methods. Companion papers will further investigate if the e-TIQH approach contributed to improvements in quality of care and how the approach was able to strengthen routine CHMT supportive supervision [35, 36].…”