Institutionalizing Quality Improvement in Tanzania: A review and a look forward
The USAID Applying Science to Strengthen and Improve Systems (ASSIST) project in Tanzania was tasked to enhance capacity of RHMT/CHMTs in 19 councils in three regions of the Southern Highlands of Tanzania to manage and lead QI efforts. The focus was on building R/CHMT teams as effective coaches who could in turn support the facility QI teams. ASSIST collaborated with the Henry Jackson Foundation (HJF) to conduct four skill-building sessions for 45 mid-level managers (29 female, 16 male) from R/CHMTs in these regions including two learning sessions and three practical orientation coaching visits.
This assessment was designed to examine the process and results of building capacity among these mid-level managers as a function of institutionalizing QI at the council and regional levels.
Between baseline and end line, mid-level managers reported an improvement in their self-assessed understanding of QI methods. At end line, respondents showed a higher level of confidence in facilitating and leading QI teams, motivating and giving opportunities to QI team members, understanding how the culture of a workplace influences quality of care, and building confidence of QI team members.
R/CHMTs who participated in an end line interviews reported providing facility QI teams with support in managing the QI team process, and providing technical assistance for QI and in monitoring and use of data for decision making. They also reported intentions to continue providing this support following the end of ASSIST.
In conclusion, mid-level managers can provide coaching support to facilities in improving the quality of care in Tanzania and may be an effective mechanism for institutionalizing QI. Efforts should be made to administratively and financially support R/CHMTs to providing further coaching to current facilities and spread changes and improvement methods to other facilities.