The quality of antenatal care in rural Tanzania: what is behind the number of visits?

Abstract Background To reduce maternal mortality in rural Tanzania, the need to improve antenatal care remains an urgent priority. Digital health tools are seen as a promising instrument to increase the quality of healthcare in developing countries, but it remains unclear to what extent they are perceived as beneficial during the antenatal care visit. Therefore, the aim of this research was to identify factors that could improve the quality of antenatal care in rural Tanzania, and whether digital health tools would change healthcare workers' and pregnant women's perceptions of quality of care. Methods Semi-structured in-depth interviews were conducted with sixteen healthcare workers and nineteen pregnant women, recruited from various health facilities in Magu District, Tanzania. Results Both healthcare workers and pregnant women possess a positive attitude towards antenatal care and acknowledge its importance. However, they also expressed a need for (structural) improvements in antenatal care services, particularly increased availability of diagnostic tests, and increased performance and motivation of healthcare workers. In addition, healthcare workers indicated a need for more training and better supervision. While both groups expected quality of care to increase should a digital health tool be implemented, they placed more focus on investing in health infrastructure, like the availability of medication and other materials, than investments in digital health. Conclusions Infrastructural improvements, including better communication between healthcare workers and pregnant women, as well as training opportunities and supportive leadership, are necessary before a digital health tool can be expected to increase the quality of antenatal care. Key messages Both healthcare workers and pregnant women acknowledged the need for higher quality antenatal care. Both groups suggested a number of infrastructural improvements, among which the use of a digital health tool.

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EFFECTIVENESS OF USING MCH BOOKS AND MONSCA APPLICATIONS IN THE IMPLEMENTATION OF 14 T ANTENATAL SERVICE STANDARDS

Jurnal Riset Kesehatan Poltekkes Depkes Bandung ◽

10.34011/juriskesbdg.v12i1.870 ◽

2020 ◽

Vol 12 (1) ◽

pp. 68-73

Author(s):

Rahmawati Rahmawati ◽

Syarif Syafruddin ◽

Nontji Wena

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Continuity Of Care ◽

Control Design ◽

Sampling Technique ◽

Limited Time ◽

Control Groups ◽

Post Test ◽

Service Standards

The component of antenatal care received by pregnant women is classified as incomplete because the implementation of standard pregnancy services is still using conventional methods. There are obstacles faced by midwives, such as the limited time in a recording, which has an impact on the declining quality of antenatal care standards. This research aims to compare the effectiveness of the use of KIA books and MONSCA applications in midwives in the application of the standard Antenatal service 14 T. This research was conducted in Puskesmas Tanete and Puskesmas Bontobangun Bulukumba District. The method used in the study is experimental quasi (pre-test post-test nonequivalent control design). Using a sample of midwives in this study, as many as 36 people were divided into two groups (18 intervention groups and 18 control groups). The sampling technique in this study used purposive sampling. Data were analyzed using the Mann-Whitney Test. The results showed that there was a difference in the effectiveness of using KIA books with MONSCA applications, MOSCA's applications were easier to use, faster, safer, and more accurate than KIA books. It can be concluded that the MONSCA application is more effective than KIA books. Key words: Effectiveness, Android-based Smart Continuity of Care application, KIA book, Antenatal service 14 T

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Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03880-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephan Brenner ◽

Caterina Favaretti ◽

Julia Lohmann ◽

Jobiba Chinkhumba ◽

Adamson S. Muula ◽

...

Keyword(s):

Quality Of Care ◽

Health Services ◽

Antenatal Care ◽

Service Provision ◽

Child Health Services ◽

Negative Externalities ◽

Positive Externalities ◽

Performance Based Financing ◽

A Performance

Abstract Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care. Methods We explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations. Results Our study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi. Conclusions Prior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

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Health status and quality of life among older adults in rural Tanzania

Global Health Action ◽

10.3402/gha.v3i0.2142 ◽

2010 ◽

Vol 3 (1) ◽

pp. 2142 ◽

Cited By ~ 27

Author(s):

MathewA. Mwanyangala ◽

Charles Mayombana ◽

Honorathy Urassa ◽

Jensen Charles ◽

Chrizostom Mahutanga ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Health Status ◽

Rural Tanzania

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Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab049 ◽

2021 ◽

Vol 33 (2) ◽

Author(s):

Yubraj Acharya ◽

Nigel James ◽

Rita Thapa ◽

Saman Naz ◽

Rishav Shrestha ◽

...

Keyword(s):

Quality Of Care ◽

Mixed Methods ◽

Antenatal Care ◽

Quality Care ◽

National Level ◽

Poor Quality ◽

Public Hospitals ◽

World Health ◽

Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

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