Quality Improvement for Maternal and Newborn Health in Mtwara Region, Tanzania (IMCHA)
Programs and partnerships
Lead institution(s)
Summary
This project will provide evidence for how systems-wide quality improvements can enhance maternal and newborn health outcomes at the district, health facility, and community levels in Tanzania.
Healthy women, healthy babiesRead more
This project will provide evidence for how systems-wide quality improvements can enhance maternal and newborn health outcomes at the district, health facility, and community levels in Tanzania.
Healthy women, healthy babies
Maternal and newborn health outcomes in southern Tanzania's Mtwara region are poor despite 70% of births occurring at health facilities. Recent research in the region found that maternal and newborn mortality rates were similar when comparing home births with health facility births. This suggests a clear need for improved quality of skilled care in health facilities.
Another issue is poor health-seeking behaviours among women. Combined with weaknesses in the health system, these factors limit the use of high quality interventions that have been proven to reduce maternal and neonatal morbidity and mortality.
Strategies to improve quality
The Ifakara Health Institute, Tanzania's Ministry of Health, and Canada's SickKids Centre for Global Health have tested and applied quality improvement strategies for mothers and newborns across six districts in southern Tanzania. This project will explore if these strategies can be scaled up and integrated into district-level health systems. It will also examine whether these strategies for higher quality maternal and newborn health care services, better care-seeking, and improved health outcomes can be sustained at the regional level.
Researchers will produce a model that can be streamlined and integrated into existing structures within the Tanzanian health system. It will generate evidence needed to inform national policy on quality improvement in Tanzania.
Project partners
This project is part of the Innovating for Maternal and Child Health in Africa program. The program is a seven-year $36 million initiative funded by Foreign Affairs, Trade and Development Canada (DFATD), Canada's International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR).
Research outputs
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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.
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.
‘Realist evaluation’ begins by establishing an initial programme theory, then identifying opportunities that support skill- and confidence-strengthening for optimising quality improvement (QI) as an implementation research approach. In this paper QI refers to participatory approaches through which stakeholders identify context-specific problems, and create and implement solutions. Local data are collected to determine whether improvements have been made; the entire process is data-driven. The realist evaluation process can generate better understanding about how health systems building blocks may be strengthened through QI processes.
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.
