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Towards improved health service quality in Tanzania: An approach to increase efficiency and effectiveness of routine supportive supervision

Author

Listed:
  • Sabine Renggli
  • Iddy Mayumana
  • Dominick Mboya
  • Christopher Charles
  • Justin Maeda
  • Christopher Mshana
  • Flora Kessy
  • Fabrizio Tediosi
  • Constanze Pfeiffer
  • Alexander Schulze
  • Ann Aerts
  • Christian Lengeler

Abstract

Effective supportive supervision of healthcare services is crucial for improving and maintaining quality of care. However, this process can be challenging in an environment with chronic shortage of qualified human resources, overburdened healthcare providers, multiple roles of district managers, weak supply chains, high donor fragmentation and inefficient allocation of limited financial resources. Operating in this environment, we systematically evaluated an approach developed in Tanzania to strengthen the implementation of routine supportive supervision of primary healthcare providers. The approach included a systematic quality assessment at health facilities using an electronic tool and subsequent result dissemination at council level. Mixed methods were used to compare the new supportive supervision approach with routine supportive supervision. Qualitative data was collected through in-depth interviews in three councils. Observational data and informal communication as well as secondary data complemented the data set. Additionally, an economic costing analysis was carried out in the same councils. Compared to routine supportive supervision, the new approach increased healthcare providers’ knowledge and skills, as well as quality of data collected and acceptance of supportive supervision amongst stakeholders involved. It also ensured better availability of evidence for follow-up actions, including budgeting and planning, and higher stakeholder motivation and ownership of subsequent quality improvement measures. The new approach reduced time and cost spent during supportive supervision. This increased feasibility of supportive supervision and hence the likelihood of its implementation. Thus, the results presented together with previous findings suggested that if used as the standard approach for routine supportive supervision the new approach offers a suitable option to make supportive supervision more efficient and effective and therewith more sustainable. Moreover, the new approach also provides informed guidance to overcome several problems of supportive supervision and healthcare quality assessments in low- and middle income countries.

Suggested Citation

  • Sabine Renggli & Iddy Mayumana & Dominick Mboya & Christopher Charles & Justin Maeda & Christopher Mshana & Flora Kessy & Fabrizio Tediosi & Constanze Pfeiffer & Alexander Schulze & Ann Aerts & Christ, 2018. "Towards improved health service quality in Tanzania: An approach to increase efficiency and effectiveness of routine supportive supervision," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-23, September.
  • Handle: RePEc:plo:pone00:0202735
    DOI: 10.1371/journal.pone.0202735
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    References listed on IDEAS

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    1. Mayumana, Iddy & Borghi, Jo & Anselmi, Laura & Mamdani, Masuma & Lange, Siri, 2017. "Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania," Social Science & Medicine, Elsevier, vol. 179(C), pages 61-73.
    2. Yoko Akachi & Margaret E. Kruk, 2017. "Quality of care: Measuring a neglected driver of improved health," WIDER Working Paper Series wp-2017-135, World Institute for Development Economic Research (UNU-WIDER).
    3. Marzia Lazzerini & Venera Shukurova & Marina Davletbaeva & Kubanychbek Monolbaev & Tatiana Kulichenko & Yuri Akoev & Maya Bakradze & Tea Margieva & Ilya Mityushino & Leyla Namazova-Baranova & Elnura B, 2017. "Improving the quality of hospital care for children by supportive supervision: A cluster randomized trial, Kyrgyzstan," WIDER Working Paper Series wp-2017-140, World Institute for Development Economic Research (UNU-WIDER).
    4. Yoko Akachi & Margaret E. Kruk, 2017. "Quality of care: Measuring a neglected driver of improved health," WIDER Working Paper Series 135, World Institute for Development Economic Research (UNU-WIDER).
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