title: Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania.
abstract: Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff.
  
  
  
  An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed.
  
  
  
  For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011-2013, with a quality score <75 % classed as 'unsatisfactory'. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3-7 % in mean score, with the most pronounced improvements in staff motivation and job expectations.
  
  
  
  Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed.
authors.affiliation: Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania.
authors.forename: Dominick
authors.initials: D
authors.lastname: Mboya
authors.affiliation: Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mshana
authors.affiliation: Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania.
authors.forename: Flora
authors.initials: F
authors.lastname: Kessy
authors.affiliation: KIT Biomedical Research, Royal Tropical Institute, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Alba
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstr. 57, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstr. 57, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Renggli
authors.affiliation: Novartis Foundation, Novartis Campus, Forum 1-3.92, 4002, Basel, Switzerland.
authors.forename: Bart
authors.initials: B
authors.lastname: Vander Plaetse
authors.affiliation: Ministry of Health, Community Development, Gender, Elderly and Children, Samora Avenue, Dar es Salaam, United Republic of Tanzania.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mohamed
authors.affiliation: Novartis Foundation, Novartis Campus, Forum 1-3.92, 4002, Basel, Switzerland. alexander.schulze@eda.admin.ch.|Swiss Agency for Development and Cooperation, Freiburgstr. 130, 3003, Berne, Switzerland. alexander.schulze@eda.admin.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schulze
mesh_terms: D001331:Automation; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000458:organization & administration; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D009042:Motivation; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D013636:Tanzania
keywords: Quality assessment tool; Quality of health services; Supportive supervision; Tanzania; Universal health coverage