title: Barriers to conducting effective obstetric audit in Ifakara: a qualitative assessment in an under-resourced setting in Tanzania.
abstract: OBJECTIVE
  To explore barriers to and solutions for effective implementation of obstetric audit at Saint Francis Designated District Hospital in Ifakara, Tanzania, where audit results have been disappointing 2 years after its introduction.
  
  
  METHODS
  Qualitative study involving participative observation of audit sessions, followed by 23 in-depth interviews with health workers and managers. Knowledge and perceptions of audit were assessed and suggestions for improvement of the audit process explored.
  
  
  RESULTS
  During the observational period, audit sessions were held irregularly and only when the head of department of obstetrics and gynaecology was available. Cases with evident substandard care factors were audited. In-depth interviews revealed inadequate knowledge of the purpose of audit, despite the fact that participants regarded obstetric audit as a potentially useful tool. Insufficient staff commitment, managerial support and human and material resources were mentioned as reasons for weak involvement of health workers and poor implementation of recommendations resulting from audit. Suggestions for improvement included enhancing feedback to all staff and managers to attend sessions and assist with the effectuation of audit recommendations.
  
  
  CONCLUSIONS
  Obstetric staff in Ifakara see audit as an important tool for quality improvement. They recognise, however, that in their own situation, insufficient staff commitment and poor managerial support are barriers to successful implementation. They suggested training in concept and principles of audit as well as strengthening feedback of audit outcomes, to achieve structural health care improvements through audit.
authors.affiliation: Department of Obstetrics and Gynaecology, Saint Francis Designated District Hospital, Ifakara, Tanzania. koenvanhamersveld@gmail.com
authors.forename: Koen T
authors.initials: KT
authors.lastname: van Hamersveld
authors.forename: Emil
authors.initials: E
authors.lastname: den Bakker
authors.forename: Angelo S
authors.initials: AS
authors.lastname: Nyamtema
authors.forename: Thomas
authors.initials: T
authors.lastname: van den Akker
authors.forename: Elirehema H
authors.initials: EH
authors.lastname: Mfinanga
authors.forename: Marianne
authors.initials: M
authors.lastname: van Elteren
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D054869:Clinical Audit / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007407:Interviews as Topic; D009774:Obstetrics / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D013636:Tanzania