Day 2 panel 4 quality improvement for mnh tz 108020

1. Title of IMCHA Project
Quality Improvement for Maternal and Newborn Health At District-level Scale in Mtwara
Region, Tanzania (QUADS)
Title of Synergy Proposal
Increasing understanding of and engagement with the quality of maternal and newborn
care at the district level in southern Tanzania
Names of Implementation Research Team
Dr Fatuma Manzi, PI
Dr Aifello Sichalwe, Co PI - Policy
Prof. Zulfiqal Bhutta, Co PI – Canada
Nadia Akseer – Canada - Investigator
Prof. Claudia Hanson – LSHTM – Investigator
Dr Tara Tancred – LSHTM – Investigator
Dr Arafumin Petro - Tanzania Investigator
Elibariki Mkumbo - Tanzania Investigator
Gumi Abdallah - Tanzania Investigator

2. QUADS Project Overview
Background
• There is lack of interventions that engage both supply-side (health services) and demand-side (health-seeking)
• Quality improvement is a bottom-up problem solving approach that can be used to strengthen health systems
to improve both the quality of and the demand for maternal and newborn health services
• Proof of concept already established 2011-14
Research questions/objectives
• How can quality improvement be scaled up using routine system
• For improved MNCH outcomes?
Methods
• Quality improvement at 3 levels- community, health facility, district
• Intervention: quarter learning sessions, improved management of services,
improved data collection & use
• Apply collaborative quality improvement approach & realist evaluation
• Quantitative analysis of HMIS, contextual documentation and costing
What are we trying to accomplish?
How will we know that a change is an
improvement?
What change can we make that will
result in improvement
Collaborative Model for Improvement
Act Plan
Study Do

3. Report Cards for community level

4. Results to Date/Key Lessons Learned
1. Building the proper attitudes towards QI to the teams – Behaviour change
• Through training, coaching and mentorship –
• Activation of QI Teams at the CHMT levels and health facilities
• Involving all the staff not some selected members – district and facilities
• Whatsapp group for health workers
2. Integrated supportive supervision & mentorship to the lower facilities
• Using simple checklist that can be used by any member when they even
go for a different activity – thus are able to checkup on maternal and
newborn services.
• Change in timing of supervision - to conduct supervision anytime of the
day
3. Strengthened the use of data at the point of collection to inform quality
improvement programming
• Created linkages of MNH interventions at District (CHMT) level with those
at the facilities
• Districts have real time information about their facilities - timely support
4. Sharing of experiences with stakeholders – districts, regional & national
health summit

5. Capacity building and next steps
Capacity Strengthening
• Attendance to various short term trainings organized by the institution and HPRO
• Application to masters level
• Inviting students to use data for dissertations
Next Steps (Plan for 2017) and Areas for Collaboration
• Strengthen implementation of quality improvement in health facilities, improve the teams
capacity deliver quality care
• Initiate implementation at community level in a scale-up model where the existing routine
system is more responsible for the operationalization.
• At district and regional level to work together to increase the buy-in where quality
improvement is streamlined and linked health service management to improve population
health
• At National level to engage in policy discussion related to quality improvement harmonization
• Through involvement in technical working groups and specific meetings related to it

6. Challenges
• The lack of readiness of the health system for service delivery – key supplies
• Shortage of staff in the facilities hence failure to comply with the QI standard
• Staff turn over – complete change in management team at the regional level - RHMT
• Those involved in different inception meetings have been shifted to other regions
• QUADS Project has suffered a negative blow
Mitigation strategies
• Strategizing to have more engagement with the RHMT
• Strengthen logistic system at district level
• Synergy grant to focus on role of policy makers – electronic data - timely collection and
synthesis, packaging successful change packages and spread to other areas in the districts
and region.

7. Synergy Proposal Overview
• Background
• Quality improvement enlists local stakeholders in defining context-specific problems and creating
strategies to address these problems
• However current there is a missing platform to get decision- makers and health facility staff to engage with
information about quality of care such that they can turn this knowledge into action.
• Research questions/objectives
i. Establish a novel electronic tool to measure quality of care that will be integrated into HMIS
ii. Use data from this tool to empower quality improvement processes at the district & health facility levels
iii. Develop scalable change packages that could be used by stakeholders at different levels to improve
maternal and newborn health
iv. To provide valuable information to decision-makers and frontline health facility staff about measuring
quality of care and using this data to improve services.
• Methods
• Deployment of electronic tool to measure quality of MNH
• Collaborative approach

8. Focus of Work in Synergy - Areas for Strategic Consideration
• Electronic data collection of quality data on MNCH linked to HMIS
• That will increase decision-maker engagement in understanding—and acting
to improve—quality of care
• Providing a platform through which data can be:
• Acted on to achieve desirable improvements in care
• Strengthen HMIS and overall health system
• Positioning to inform the WHO network for improving quality of care for MNCH
• Tanzania is among the first wave countries -
http://www.who.int/pmnch/media/events/2017/lilongwe/en/

9. Thanks