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Rose Mnzava
Quality Improvement Advisor Jhpiego/MAISHA Tanzania
Presentation Outline
1. Background 2. SBM-R assessment findings from baseline to date in MAISHA-supported regional hospitals 3. Challenges/ lessons leant and summary
Background
Quality improvement in Tanzania is a process to improve quality of maternal and neonatal care Measures actual performance and quality of services in a facility
Background
The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths 2008 - 2015
Strategies include:
Improving access to quality MNH care Strengthening the referral system Strengthening MNH district health planning& management of Advocating for increased commitment & resources for MNH Fostering partnerships Promoting the household to hospital continuum of care Empowering communities
Standards
Normal labour delivery & immediate newborn care (NLD) Management of antenatal, intrapartum and postpartum complications (MCLD) Postpartum care (PNC) Infrastructure& human resources (IHR) IEC & Community participation (IEC) Support systems (SS)
Hospitals
20 15
10 11 4 17
8 7 13
Total
77
58
Implementing Standards: A continuous process Used performance standards to Identify quality of care gaps Share results with technical personnel to guide program plans and implementation to address the identified gaps
Intervention Identification
PERFORMANCE FACTORS Capacity GAP
Knowledge/ skills & information
Opportunity
Resources / Tools
Motivation
Developed a network of SBM-R promoters and facilitators Strengthening use of standards based management and recognition approach to quality of care in HFs Supporting Quality Improvement Teams (QITs) to Link up with Health Facility Management Teams (HMTS) Promoting the use of SBM-R performance standards tool for Supportive Supervision
Ligula
Sokoine
Baseline
Mt. Meru
Mawenzi
3rd Internal
Iringa
4th Internal
Kigoma
1st Internal
2nd Internal
0%
Babati Tumbi Songea Baseline Kitete 1st Inter Morogoro 2nd Inter Temeke 3rd Inter M'nyamala Amana
hospital 1
Baseline 1st internal 2nd internal
hospital2
3rd internal
hospital3
Postpartum Care
hospital 1
Baseline
hospital2
hospital3
3rd internal
1st internal
2nd internal
Achievements cont.
All hospitals have shown performance improvement overtime Task shifting noticeable
Challenges
Shortage
of skilled human resource Provider attitude Shortage of equipment and supplies Drug stock outs High staff turnover
Lessons Learnt
Supportive supervision is an integral part of SBMR Involvement of stakeholders and getting their buy-in & commitment Building the capacity of RHMTs, CHMTS HMTs and supervisors on supportive supervision Strengthening and linking health facilities with communities Post training follow up ensure translation of trainings into services Use of systemic holistic approach
CONCLUSIONS
Providing clearly defined MNH performance standards results Putting simple and easy to use QI approaches into the hands of providers Steady performance has been documented Providers competence improved
Summary
Tanzania EmONC/BEmONC QI process has illustrated a shift from policy to practice with an important lesson that it is a managerial tool. Application of the tools lead to identification and addressing performance gaps which has shown improvement in quality of EmONC/BEmONC Multisectoral strategies are required to promote shared responsibilities in order to achieve quality of care especially where external support is required.
Acknowledgements
Authors: Rose Mnzava, Gaudiosa Tibaijuka, Marya Plotkin, Dunstan Bishanga, Maryjane Lacoste
Institutions: Jhpiego Tanzania
This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID) Cooperative Agreement No. 621-A-00-08-00023-00. The contents are the responsibility of the Mothers and Infants, Safe Healthy Alive (MAISHA) program and do not necessarily reflect the views of USAID or the United States Government.