Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare

Sabine Renggli,Flora Kessy,Alexander Schulze,Christopher Mshana,Constanze Pfeiffer,Ann Aerts,Iddy Mayumana,Christopher Charles,Tracy R Glass,Christian Lengeler,Dominick Mboya

doi:10.1186/s12913-019-4648-2

Abstract

BackgroundUniversal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision.MethodsMixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements.ResultsThe results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts.ConclusionTogether with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.

Highlights

Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured
There is no benefit to Universal Health Coverage (UHC) if poor quality of care leads to unwillingness of people to use services [4]
Council Health Management Teams (CHMTs), who are in charge of managing services provided within their council, are often conducting routine supportive supervision of healthcare providers inadequately and ineffectively [16, 17, 19]

Summary

Introduction

Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. One of the main challenges resulting in weak quality in low- and middle-income countries is the lack of enough, well-trained and motivated staff with adequate financial and physical resources to provide basic health services [11, 12]. Another problem is insufficient resources and/or ineffective and inefficient allocation of limited resources [12, 13]. Given the need to improve quality of care and strengthen routine supportive supervision of healthcare providers through their CHMT, we systematically evaluated a new supportive supervision approach that aimed to serve this purpose

Objectives

Methods

Results

Discussion

Conclusion