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. 2018 Apr 16;31(3):190-202.
doi: 10.1108/IJHCQA-10-2015-0122.

Improving Tanzanian childbirth service quality

Jennie Jaribu  1 , Suzanne Penfold  2 , Cathy Green  3 , Fatuma Manzi  4 , Joanna Schellenberg  5
Affiliations

Improving Tanzanian childbirth service quality

Jennie Jaribu et al. Int J Health Care Qual Assur. .

Abstract

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Keywords: Birth plan; Health facility delivery; Partograph; Pregnancy danger signs; Quality improvement; Tanzania.

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Figures

Figure 1
Figure 1
Improvement collaborative model
Figure 2
Figure 2
Median health facility deliveries per facility in Mtwara Rural collaborative (four facilities) from January 2009 to September 2010
Figure 3
Figure 3
Median Health facility deliveries per facility in Ruangwa collaborative (23 facilities) from January 2009 to June 2011
Figure 4
Figure 4
Median deliveries per facility in which partographs were completed in Ruangwa collaborative (23 facilities) from January 2009 to June 2011
See this image and copyright information in PMC

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