Improving quality of services delivered in primary health care facilities
Improving the quality of health services is essential for the health and wellbeing of a population, including reducing maternal and childhood mortality. The Tanzanian government has prioritised the improvement of quality services, but this has been hampered by various factors including a lack of funds and a limited number of skilled providers.
Options worked as part of the Tanzania German Programme to Support Health (TGPSH), funded by GIZ, to improve quality of care in regional and district hospitals in four regions. Our work has strengthened overall health administration and prioritised quality as an essential component of service delivery.
We worked at national and regional level to create a conducive framework for quality improvement in the country.
National level: We supported the Ministry of Health to develop a road that will inform subsequent steps to develop accreditation systems for health facilities in Tanzania.
We’re also supporting the country to develop health sector specific client complaint guidelines, partly informed of our support to complaint mechanisms in regional and district hospitals in the four regions. The guidelines will enable clients to lodge complaints, opinions or compliments to inform client centred service provision.
Regional level: Our Regional Quality Improvement Advisors worked closely with government counterparts in Regional and Council Health Management Teams to implement a culture of quality across facilities, and build the capacity through mentoring, coaching and training. We also supported the Regional and Council Health Management Teams by providing technical advice and establishing functional quality improvement structures. We introduced regular supportive supervision in the facilities, to ensure quality improvement remains a constant agenda at regional, council and hospital levels aiming to improve the quality of services delivered.
Our approach to quality improvement has resulted in a dramatic increase in the quality of services delivered in the four regions, along with a marked increase in patient satisfaction, from 48.9% in 2016 to 70.6& in 2017.
- A roadmap that details the steps needed to develop a national accreditation system for all health facilities in Tanzania has been produced. The roadmap will be crucial in setting up national accreditation systems in the future.
- We helped set up quality improvement structures and teams in 22 district hospitals, and developed plans for responding to gaps in quality of care. This has resulted in 18 out of 22 health facilities reaching minimum national quality level or higher, compared with only 2 facilities at baseline in 2016.
- All 28 supported hospitals (22 district hospitals, 4 regional hospitals and 2 hospitals at regional level) implemented annual quality improvement plans.
- Through these efforts, care satisfaction among female clients improved from 48.9% in 2016 to 70.6% in 2017. This was a result of increased mentoring and a focus on quality.
- All 28 supported hospitals have functional client complaint mechanisms
- Support to quality improvement has been strengthened to involve regional and district administrative leadership which has helped to attract more resources and prioritisation of quality improvement beyond the health sector
Within 1 year, 18 out of 22 supported facilities met the minimum quality criteria, up from only 2 at baseline
Satisfaction with services among female clients improved from 48.9% at baseline compared to 70.6% a year later