The Government of Tanzania has recognised the importance of health care quality, creating a five-star rating system for assessing primary care level health facilities. Facilities given a rating lower than three-stars, were deemed to have failed this quality assurance test. Within the regions of Mbeya, Tanga, Lindi, and Mtwara, just two district hospitals reached the pass rate. The German government funded the Tanzanian German Programme to Support Health (TGPSH) to change this, with Options providing technical support to improve quality of care.
To identify where improvements needed to be made, TGPSH established a complaints system for patients. Most facilities had previously been unable to gather this kind of feedback, with just six of the 28 hospitals having established a complaints mechanism. To counter this, TGPSH helped establish complaint, compliment and suggestion offices and trained staff to handle patient feedback. TGPSH supported the hospitals, helping them to analyse complaints and suggestions, identifying areas where improvements needed to be made. The programme has created a manual to enable hospitals across Tanzania to roll out a uniform and cohesive complaints system, granting more hospitals access to feedback.
This system combined with the results from the government’s star rating assessment and routine quality improvement implementation, helped hospitals locate gaps and weaknesses in their services. Plans for improvement were constructed, based on this data, implemented and regularly monitored to capture progress and challenges. Each hospital created their own tailor-made plan of action, with staff forming smaller task-forces to focus on problem areas at each level of the quality improvement structure. By narrowing in on specific issues which effected individual facilities, they hoped to raise their star-rating along with standards.
Hospital staff across the selected regions were encouraged to learn from each other through peer learning, using successful facilities’ expertise to plug gaps in their knowledge. TGPSH initiated coaching schemes, using the programme’s regional networks to source staff members with the required expertise to run guidance sessions and workshops.
“We lacked a triaging unit in our hospital because we did not have someone trained in the field. We scored zero [on this indicator] in the initial assessment in 2016,” explained one staff member working to improve quality in Korgwe District Hospital. “Through this training, we’ve established a [triaging] unit at our hospital and we scored well on this indicator during the last star rating assessment.”
Staff from slower developing facilities also visited better performing hospitals to take part in peer-to-peer learning and adopt successful techniques. Pangani District hospital addressed their waste management system after visiting a neighbouring hospital. Kilwa District Hospital was inspired to improve services, applying for loans to buy a theatre lamp and ultrasound equipment after a peer-to-peer visit. They made simple changes to improve patient waiting times, investing in clearer signage and paving corridors to guide and ease patient flow, increase service providers to reduce congestion, learning from their colleagues and improving care.
These efforts have all had an impact on patient experience and feedback has given a clear indication of improvement. In 2016, less than half of patients were satisfied with their care, yet two years later, 86.8% found services satisfactory. Two regions saw their satisfaction rates double. Hospitals were encouraged to conduct self-assessments, six months after the official government star-rating, to redefine targets and accelerate improvements. By gathering feedback and creating targets based on this, staff in all hospitals were able to raise standards significantly.
Before TGPSH intervened, there were no hospitals within the four Tanzanian regions ranked above three stars. By the end of the programme, more than half of facilities surpassed the acceptable level, achieving a four-star rating. With 14 four-star and 8 three-star hospitals after just two years, TGPSH’s efforts to improve quality can be judged a success. TGPSH methods have proved that identifying weaknesses and addressing gaps in healthcare systems can raise standards, providing high-quality care in Tanzania.