Category Archives: Quality of Services

Enhancing Core Competencies & Improving Midwifery Quality of Care in Lake Zone, Tanzania

With support from USAID’s Maternal and Child Survival Project in Tanzania Annamagreth Mukwenda, John George George, Mary Rose Giatas, Agrey Mbilinyi, Gustav Moyo, and Justine Ngenda have been addressing the quality of case and services provided by midwives. Their poster at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene is summarized below.

In sub-Saharan Africa, maternal mortality is unacceptably high accounting for 56% of all maternal deaths. Tanzania is not different. It is estimated that five in every 100 children die before their first birthdays and that four women out of 1000 live births die due to pregnancy related causes.

With prompt recognition and timely intervention most maternal and neonatal deaths can be avoided. Access to skilled care at these critical times save lives.

A new initiative is working to improve midwifery care by building capacity of training institutions to prepare highly skilled nurse-midwives to enhance on job live saving skills.
In 2014 A collaboration between the Tanzania Ministry of Health, Jhpiego through Maternal child survival program (MCSP), conducted a baseline assessment to assess the quality of midwifery pre-service education to adequately prepare students with the clinical skills to provide competent nursing and midwifery care.

Four nursing and midwifery schools from two regions of Lake Zone were assessed to identify issues affecting the schools’ ability to produce clinically competent graduates in nursing and midwifery. Among things, the assessment focused on tutors and recent graduates, with findings showing critical deficit on content/skill competencies.

To address these challenges, midwifery tutors from 9 schools (100%) were updated in high impact midwifery interventions through trainings and supportive supervision including coaching and mentorship. Skills labs were also equipped with all mannequins necessary for midwifery training.

The program is in the third year of implementation with tremendous improvement in midwifery training as evidenced by students final examination results as well as tutors’ and students’ testimonies.

Experience of MCSP approach to strengthen competencies of graduates has contributed to improve midwifery quality of care to reduce maternal deaths in Tanzania.

Implementation of a Quality Improvement Approach for Malaria Service Delivery in Zambezia Province, Mozambique

Baltazar Candrinho, Armindo Tiago, Custodio Cruz, Mercino Ombe, Katherine Wolf, Maria da Luz Vaz, Connie Lee and Rosalia Mutemba are sharing their work during a scientific session on enhancing quality of care for malaria services in Mozambique at the 66th Annual Meeting of the American Society of Tropical Medicine 66th Annual Meeting on 6 November 2017. A summary of their talk follows:

In Mozambique, malaria in pregnancy (MIP) is one of the leading causes of maternal and newborn morbidity and mortality. Malaria also accounts for over 40% of deaths in children less than five years old. With provincial and facility-level commitment, a simple and comprehensive quality improvement (QI) system has been established in 10 of 16 districts in Zambezia Province.

Since 2016, the Mozambique Ministry of Health (MOH) and Zambezia Provincial Health Directorate, in collaboration with partners, have implemented a malaria QI effort based on the Standards-Based Management and Recognition (SBM-R) approach. A standards-based approach to improving quality of malaria care engages both management and service providers to work together to assess the current performance, address gaps to ensure that all patients receive a minimum (standardized / evidence-based) package of care, and ultimately improve patient outcomes and facility performance.

Thirty-one performance standards in five content areas (MIP, Case Management, Laboratory, Pharmacy, and Management of Human Resources and Malaria Commodities) were developed and adopted by the MOH in 2016. With support from partners, 40 health workers, including managers, clinicians and lab technicians, received training on SBM-R, and facility QI teams were established.

These teams use checklists based on standards to conduct quarterly assessments that identify performance gaps, and then develop action plans to address areas of improvement. The MOH antenatal care and child health registers also contain information on coverage of key malaria interventions, including IPTp, and malaria diagnosis and treatment during pregnancy and for children under five with fever.

Average attainment of standards at baseline in 20 health facilities was 30%, and is expected to improve as implementation progresses with quarterly application of the checklist (data will be available before November). Improvements in key malaria indicators for pregnant women and children under five years old are expected as the percentage of standards attained increases.

Institutionalization of Quality of Care in Health Facilities Improves Management of Malaria in Pregnancy in Tanzania

Jasmine W. Chadewa and Rita Mutayoba of Jhpiego’s Dar es Salaam, Tanzania, office are presenting a poster at the 64th ASTMH Annual Meeting in Philadelphia at noon on Tuesday 27th October 2015. Please stop by Poster 680 and discuss the results as presented in the Abstract below.

IPTp picture aidMalaria in Pregnancy (MiP) is one of the contributors to maternal mortality in Tanzania which persists at a ratio of 410/100,000 live births. Tanzania implements WHO’s three-pronged approach to prevent MiP (use of insecticide treated bednets (ITNs), intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) and prompt diagnosis and treatment).

Efforts are ongoing to improve IPTp and ITN coverage which is 33% and 75%, respectively. Jhpiego, in collaboration with the Ministry of Health and Social Welfare, worked in 251 health facilities to improve the quality of maternal and neonatal health by building the capacity of health care providers through training, supportive supervision, mentoring and coaching. A total of 7,181 providers and 400 tutors were trained on MiP prevention and treatment.

A quality of care study used the same methodology and sampling approach in 2010 and 2012, combining observations of women during antenatal care, inventory and record review as well as health worker knowledge. A team of MNH experts underwent clinical updates, training and orientation to the study tools.

mother & child TanzaniaData collection teams visited facilities, made observations and entered data into smart phones. The study was conducted in 12 regional hospitals and 38 lower level facilities in 12 regions including Zanzibar with a total of 391 and 366 ANC observations made in 2010 and 2012, respectively.

Between 2010 and 2012, the percentage of women receiving an ITN increased by 26% (p value = <0.0001). The change observed was due to a 33% increase in offering ITN vouchers at health centers and dispensaries. A slight improvement was seen in provision of IPTp(SP) from 62% in 2010 to 65% in 2012.

In Tanzania, application of the quality improvement approach contributed to improving MiP services. Moving forward, there is a need for the Ministry to continue strengthening ANC with effective monitoring and routine supervision to increase coverage of MiP prevention. Districts management teams and facilities need to ensure availability of SP and provide regular technical updates on the national service standards including counseling at ANC and birth preparedness.