title: Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania.
abstract: A quality improvement intervention for maternal and newborn health was carried out in southern Tanzania at the community level. It sought to improve health-seeking behaviors and uptake of community-level maternal and newborn health practices. A process evaluation populated using data primarily from in-depth interviews and focus group discussions with the intervention's implementers was undertaken in four villages receiving the intervention to evaluate the intervention's implementation, uncover facilitators and barriers of quality improvement, and highlight contextual factors that might have influenced implementation. Performance implementation scores were used to rank the villages. Identifying higher- and lower-performing villages highlighted key facilitators and barriers of community-level quality improvement related to support from local leaders, motivation through use of local quality improvement data, and regular education around quality improvement and maternal and newborn health. These findings can be taken formatively in the design of similar interventions in the future.
authors.affiliation: 1 London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Tara
authors.initials: T
authors.lastname: Tancred
authors.affiliation: 2 Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Fatuma
authors.initials: F
authors.lastname: Manzi
authors.affiliation: 1 London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
authors.affiliation: 1 London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Tanya
authors.initials: T
authors.lastname: Marchant
mesh_terms: D000328:Adult; D002662:Child Health Services / Q000458:organization & administration*; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011247:Pregnancy; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D013636:Tanzania
keywords: behavior change; capacity and development; community-based programs; health seeking; process evaluation; qualitative research; quality of care; social participation; sub-Saharan Africa