Abstract
BackgroundImplementation of evidence into practice is inadequate in many low-income countries, contributing to the low-quality care of mothers and newborns. This study explored strategies used in a facilitation intervention to improve postpartum care (IPPC) in a low-resource suburb in Dar es Salaam, Tanzania. The intervention was conducted during 1 year in government-owned health institutions providing reproductive and child health services. The institutions were divided into six clusters based on geographic proximity, and the healthcare providers of postpartum care (PPC) (n = 100) in these institutions formed IPPC teams. Each team was supported by a locally recruited facilitator who was trained in PPC, group dynamics, and quality improvement. The IPPC teams reflected on their practices, identified problems and solutions for improving PPC, enacted change, and monitored the adopted actions.MethodsA qualitative design was employed using data from focus group discussions with healthcare providers (n = 8) and facilitators (n = 2), and intervention documentation. The discussions were conducted in Kiswahili, lasted for 45–90 min, were audio-recorded, transcribed verbatim, and translated into English. Thematic analysis guided the analysis.ResultsFour main strategies were identified in the data: (1) Increasing awareness and knowledge of PPC by HCPs and mothers was an overarching strategy applied in training, meetings, and clinical practice; (2) The mobilization of professional and material resources was achieved through unleashing of the IPPC teams’ own potential to conduct PPC and act as change agents; (3) Improving documentation and communication; and (4) Promoting an empowering and collaborative working style were other strategies applied to improve daily care routines. The facilitators encouraged teamwork and networking among IPPC teams within and between institutions.ConclusionThis facilitation intervention is a promising approach for implementing evidence and improving quality of PPC in a low-resource setting. Context-specific actions taken by the facilitators and healthcare providers are likely integral to the successfulness of implementing evidence into practice. The results contribute to increasing the understanding of facilitation as an intervention and can be useful for researchers, HCPs, and policymakers when improving quality of postpartum care, particularly in low-income settings.
Highlights
Implementation of evidence into practice is inadequate in many low-income countries, contributing to the low-quality care of mothers and newborns
The current study describes the contextually driven strategies used in the Improving Postpartum Care (IPPC) intervention in Tanzania
Aim of the study The aim of this study was to explore the strategies used by facilitators and healthcare providers (HCPs) within a facilitation intervention to improve postpartum care (PPC) in government-owned health institutions in Ilala suburb in Dar es Salaam, Tanzania
Summary
Implementation of evidence into practice is inadequate in many low-income countries, contributing to the low-quality care of mothers and newborns. This study explored strategies used in a facilitation intervention to improve postpartum care (IPPC) in a low-resource suburb in Dar es Salaam, Tanzania. The institutions were divided into six clusters based on geographic proximity, and the healthcare providers of postpartum care (PPC) (n = 100) in these institutions formed IPPC teams. The IPPC teams reflected on their practices, identified problems and solutions for improving PPC, enacted change, and monitored the adopted actions. In Tanzania, the maternal mortality ratio is 556 deaths per 100,000 live births [2]. The main causes of maternal deaths in Tanzania, as globally, are haemorrhage, hypertensive disorders, sepsis, and unsafe abortions [3, 4]. In Tanzania, the neonatal mortality rate, defined as the number of neonatal deaths per 1000 live births within the first month of life [6], is estimated at 26 deaths per 1000 live births, which contributes to 40% of all under-five deaths [2]
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