Towards improved health service quality in Tanzania.

Since the publication of the World Health Report in 2010, there is growing ambition in many countries for progress towards Universal Health Coverage (UHC). This was further stimulated through the formulation of UHC as one of the prominent targets of the health-related Sustainable Development Goal 3. However, there is no benefit to UHC if the poor quality of care leads to the unwillingness of people to use services.

And even if services are accessed and used, studies suggest that poor quality is undermining health outcomes. Consequently, health services need to be of sufficient quality to achieve the desired outcomes, and therefore improving quality must be of the highest priority. Visit here; TZ Professional.

One of the main challenges resulting in weak quality in low- and middle-income countries is the lack of enough, well-trained and motivated staff with adequate financial and physical resources to provide basic health services. Another problem is insufficient resources and/or ineffective and inefficient allocation of limited resources.

Additionally, upon quality assessments district managers and healthcare providers seldom receive feedback on the performance of their facilities. As a result, assessment results are rarely translated into appropriate quality improvement measures.

It was moreover reported that many assessments seemed to measure donor-funded programs rather than country-owned initiatives, leading to parallel monitoring structures that burden the system. In Tanzania, given the expansion of health services, quality of care has become a major concern for many years.

Some of the issues are low standards of hygiene and sanitation, insufficient health infrastructure, poor healthcare waste disposal, low motivation of health workers, inadequate adherence to professional and ethical conduct, as well as a know-do gap amongst health workers.

The last point refers to the gap between what health workers know and what they actually do. Missing ownership of quality improvement measures at the facility level and poor feedback on quality developments at the council level are further issues found in Tanzania.

The topic received even greater attention in the subsequent HSSP IV (2015–2020). According to this plan, the operationalization of quality improvement ought to be done through the introduction of a performance-based certification system, clients’ charters, pay-for-performance (P4P) schemes, and an integrated quality improvement program.

The latter is supposed to include a national quality improvement toolkit and monitoring system, facility self-assessments, and comprehensive supportive supervision, mentoring, and coaching The plan is backed up by a series of basic standards for health facilities at each level of the Tanzanian healthcare system.

The HSSP IV as well specifies the need for harmonizing, coordinating, and integrating the improvement initiatives of the disease-specific national control programs Apart from these initiatives, there are also rather uncoordinated and sometimes duplicative quality improvement approaches from other stakeholders These approaches rely usually on external assessments conducted in the frame of certification or accreditation procedures, on pieces of training with subsequent follow-up visits to health facilities or on self-assessments done at health facilities].

To the best of our knowledge, none of the documented approaches looked at routine CHMT supportive supervision. Thus, given the need to improve the quality of care and strengthen routine supportive supervision of healthcare providers through their CHMT, we systematically evaluated a new supportive supervision approach that aimed to serve this purpose.


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