Strengthening QI activities at district level

This report summarizes the discussion held with the District teams in Ifakara (Tanzania) on their understanding about the Quality Improvement (QI) process and how better they can strengthen QI activities at District levels. Participants shared their experiences with the programme, while making suggestions. QI is regarded as useful in providing guidance for assessing implementation bottlenecks and in prompting solutions that address challenges

Quality improvement at district scale (QUADS) project - community intervention : implementation and process monitoring

Tanzania’s National Quality Improvement (QI) Strategic Task Force established an accelerated plan for quality improvement in maternal and newborn care, but struggles with a small evidence base. The paper reduces evidence gaps by providing a review of community QI implementation with 163 teams across 4 councils of Mtwara Region, Tanzania. The paper provides details and evaluation of the operational model for various village health facilities, as well as charting the referral process. Collaborative teams include ward executive officers who lead village executive officers to supervise community health workers (CHW) along with health facility personnel

Quality improvement at district scale (QUADS) project - health facility Intervention : implementation and process monitoring

This policy brief reviews details of the Quality Improvement (QI) intervention process and activities in four Districts in Tanzania. Quality improvement for maternal and newborn health at District scale (QUADS), aims to improve quality of performance to enable the District team to work independently of external facilitation. QI refers to systematic analysis of practice performance as well as efforts to improve health service delivery in maternal care. Regional level QUADS involves a regional health management team, comprising the Regional Medical Officer, Regional Reproductive Child Health coordinator, health management information systems personnel and a Regional Quality Improvement focal person

Beyond Antimalarial Stock-outs: Implications of Health Provider Compliance on Out-of-Pocket Expenditure during Care-Seeking for Fever in South East Tanzania.

To better understand how stock-outs of the first line antimalarial, Artemisinin-based Combination Therapy (ACT) and other non-compliant health worker behaviour, influence household expenditures during care-seeking for fever in the Ulanga District in Tanzania. We combined weekly ACT stock data for the period 2009-2011 from six health facilities in the Ulanga District in Tanzania, together with household data from 333 respondents on the cost of fever care-seeking in Ulanga during the same time period to establish how health seeking behaviour and expenditure might vary depending on ACT availability in their nearest health facility. Irrespective of ACT stock-outs, more than half (58%) of respondents sought initial care in the public sector, the remainder seeking care in the private sector where expenditure was higher by 19%. Over half (54%) of respondents who went to the public sector reported incidences of non-compliant behaviour by the attending health worker (e.g. charging those who were eligible for free service or referring patients to the private sector despite ACT stock), which increased household expenditure per fever episode from USD0.14 to USD1.76. ACT stock-outs were considered to be the result of non-compliant behaviour of others in the health system and increased household expenditure by 21%; however we lacked sufficient statistical power to confirm this finding. System design and governance challenges in the Tanzanian health system have resulted in numerous ACT stock-outs and frequent non-compliant public sector health worker behaviour, both of which increase out-of-pocket health expenditure. Interventions are urgently needed to ensure a stable supply of ACT in the public sector and increase health worker accountability

Enhancing HIV status disclosure and partners’ testing through counselling in Tanzania

Background: In Tanzania HIV Testing and Counselling (HTC) is being implemented through voluntary counselling and testing (VCT), provider initiated counselling and testing (PITC) and work place counselling and testing (HTC). Within these programmes, HIV status disclosure is emphasized. However, among persons who test HIV positive, many do not disclose their status to their partners and social networks.  However, data are lacking on the effectiveness of the different HTC strategies on HIV positive status disclosure.Objective: To investigate which of the three HIV Testing and Counselling (HTC) strategies: Voluntary Counselling and Testing (VCT), Provider Initiated Counselling and Testing (PITC) and work place Counselling and testing is associated with improved HIV-positive status disclosure in Eastern Tanzania.Methods: Structured interviews were conducted with 455 newly diagnosed HIV-positive clients at 6 HTC sites during enrolment and at three months follow-up to collect data on disclosure status.Results: We found that PITC strategy attended a relatively higher proportion of clients 182/455(40.1%) as compared to VCT 169/455 (37.1%) and work place HTC strategies 104/455(22.9%) respectively. Among clients, about one third 130/455(28.6%) were found to be HIV-positive. HIV status disclosure rates were variable and were in order of preference of disclosing to family members 86/130(66.2 %), followed by relatives 74/130(56.9%) and sexual partners 71/130(54.6%). A high proportion of participants 77/130(59.2%) experienced violence acts from sexual partners in form of stigma and discrimination, abuse, divorce and termination from employment. In the multivariate logistic regression, disclosure to sexual partners was associated with violence acts of about two times higher (Disclosure to Partners OR=1.89) when compared to the group that did not disclose to their partners.Conclusion: PITC strategy was found to result into higher rates of HIV positive status disclosure when compared to VCT and work place HTC strategies. Stigma, discrimination and violence acts are still prevalent in Tanzania and discourages HIV positive status disclosure. Based on these findings, there is an urgent need of promoting public education on HIV transmission, prevention and treatment and enhancing strategies to reduce risky sexual behaviour and increase condom use

Increasing ANC utilization : a qualitative realistic evaluation on the role of health facility quality improvement in Southern districts of Tanzania

This is a one-page introduction to the Quality Improvement (QI) programme, which is working towards increased efficiency and provision of antenatal care (ANC) in health facilities in Tanzania

Routine capturing of quality of care data using electronic tool to synergy quality improvement for maternal and newborn health at district scale (QUADS2) - Mtwara Region Southern Tanzania

The quality improvement for maternal and newborn health at district scale (QUADS2) intervention was carried out in four districts in southern Tanzania (2015-2020). The project was developed to increase data quality and use, promoting more active engagement of policy implementers. Using WHO Quality of Care indicators for maternal and newborn health (World Health Organization, 2019), an electronic tool was developed through which evaluation activities were conducted. Every month health workers uploaded data about their patients. This 2-page article reviews details of the project

Beyond antimalarial stock-outs: implications of health provider compliance on out-of-pocket expenditure during care-seeking for fever in South East Tanzania

Abstract BACKGROUND: To better understand how stock-outs of the first line antimalarial, Artemisinin-based Combination Therapy (ACT) and other non-compliant health worker behaviour, influence household expenditures during care-seeking for fever in the Ulanga District in Tanzania. METHODS: We combined weekly ACT stock data for the period 2009-2011 from six health facilities in the Ulanga District in Tanzania, together with household data from 333 respondents on the cost of fever care-seeking in Ulanga during the same time period to establish how health seeking behaviour and expenditure might vary depending on ACT availability in their nearest health facility. RESULTS: Irrespective of ACT stock-outs, more than half (58%) of respondents sought initial care in the public sector, the remainder seeking care in the private sector where expenditure was higher by 19%. Over half (54%) of respondents who went to the public sector reported incidences of non-compliant behaviour by the attending health worker (e.g. charging those who were eligible for free service or referring patients to the private sector despite ACT stock), which increased household expenditure per fever episode from USD0.14 to USD1.76. ACT stock-outs were considered to be the result of non-compliant behaviour of others in the health system and increased household expenditure by 21%; however we lacked sufficient statistical power to confirm this finding. CONCLUSION: System design and governance challenges in the Tanzanian health system have resulted in numerous ACT stock-outs and frequent non-compliant public sector health worker behaviour, both of which increase out-of-pocket health expenditure. Interventions are urgently needed to ensure a stable supply of ACT in the public sector and increase health worker accountability