Strengthening Nursing & Midwifery Training Through Implementation of Continuous Quality Improvement Process in Tanzania

Annamagreth Mukwenda, John George, Mary Rose Giatas, Gustav Moyo, and Justine Ngenda have been promoting Continuous Quality Improvement and mentoring with nurses and midwives in Tanzania. They shared their experiences working with the Maternal and Child Survival Program and Tanzanian Government agencies at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene.

Tanzania is one of the countries with critical shortage of human resource for health. The coverage of skilled birth attendants is about 50%, which connote sub-optimal quality of care contributing to poor neonatal and maternal outcomes.

Training and deploying adequate numbers of competent health workers is one of the objectives of the Tanzania National Health Policy. The government of Tanzania and partners like Jhpiego led Maternal and Child Health Survival Program, are working to improve the training environment hence competent graduates.

In support of quality trainings, Jhpiego in collaboration with the Ministry of Health are implementing the Continuous Quality Improvement (CQI) process which encourages health training institutions to improve quality teaching and learning by focusing on Classroom and Practical Instructions, Clinical instruction and practice, Institutional Infrastructure, Learning and Teaching Materials and Institutional Governance and Administration.

A baseline assessment was done using the CQI guide in 10 training institutions to assess the quality of training and educational process, output and outcomes for the provision of quality nursing and midwifery care. Results indicated substandard outcomes with scores less than 50% at most schools.

All 10 schools were oriented on CQI process including its implementation. Quarterly assessment by a team comprised of institutions’ quality improvement teams, Ministry of Health and Jhpiego were done and gaps identified addressed through supportive supervision and mentorship.

Training institution are progressively improving their training capabilities. The teaching learning environment has improved substantially with an average score 95% during external verification from 45% baseline score. After eighteen months of program implementation, three schools have been recognized for their outstanding performance and were presented with trophies and certificates as a motivation. This translates into increased number of skilled health care workers from rural nursing schools with required competency to avert maternal and neonatal deaths.

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