Perceptions and Experiences of Health Care Workers on Accountability Mechanisms for Enhancing Quality Improvement in the Delivery of Maternal Newborns and Child Health Services in Mkuranga, Tanzania

Abstract

BackgroundMaternal mortality estimates globally show that by 2017 there were still 211 deaths per 100,000 live births; more strikingly, 99% of them happen in low and middle-income countries, including Tanzania. There has been insufficient progress in improving maternal and newborn health despite the efforts to strengthen the health systems, to improve the quality of maternal health in terms of training and deploying human resources for health, constructing health facilities, and supplying medical products. However, fewer efforts are invested in enhancing accountability toward the improvement of the quality of maternal health care. This the study was conducted to explore the perceptions of healthcare workers regarding accountability mechanisms for enhancing quality improvement in the delivery of maternal newborn and child health services in Tanzania.MethodsWe adopted phenomenology as a study design to understand how health workers perceive accountability and data were collected using semi-structured interviews. We then used thematic analysis to analyze themes and sub- themes.ResultsThe study revealed four categories of perceptions namely, differences in the conceptualization of accountability and accountability mechanisms, varied opinions about the existing accountability mechanisms, perceived the usefulness of accountability mechanisms, together with perceived challenges in the enforcement of accountability mechanisms.ConclusionPerceived variations in the understanding of accountability among healthcare workers signaled a proper but fragmented understanding of accountability in maternal care. Accountability mechanisms are perceived to be useful for enhancing hard work in the provision of maternal health services. Moreover, inadequate motivation resulting from health system bottlenecks tend to constrain enforcement of accountability in the provision of maternal care services. Thus, we recommend that the government should deal with health system constraints and enforce regular monitoring and supervision.

Facilitators for and Barriers to the Implementation of Performance Accountability Mechanisms for Quality Improvement in the Delivery of Maternal Health Services in a District Hospital in Pwani Region, Tanzania

“…The study by Chrissman 2016 [19] pointed to similar findings by arguing that maternal death review committees' recommendations suffer from clearly defined and attainable action points and from specific timelines, implementation methods, and individual responsibility assigned for implementation. This kind of finding supports the idea that a lack of follow-up together with inconsistencies characterizing recommendations proposed by the maternal review committees lead to frustrations in the health system and the dedicated efforts for quality improvement in maternal health care [20].…”

“…Despite the existence of performance accountability mechanisms, such as MPDSR, M&E system, clinical meetings, and ward rounds [4], the MMR and newborn mortality reduction are not being achieved in Tanzania, or they are inequitably achieved [18][19][20]. These mechanisms are implemented by the hospital management team (HMT).…”

Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review

“…Eight studies that analysed various information and monitoring interventions are included in this review 215–222. In Mexico, the study involved benchmarking by measuring effective coverage to monitor progress, foster accountability and create a culture of evidence.…”

Quality of health service in the local government authorities in Tanzania: a perspective of the healthcare seekers from Dodoma City and Bahi District councils

“…The use of the SERVQUAL model to assess the quality of health services is significant in that health services in Tanzania were reported to face several challenges [21,29,30,35]. However, the researchers concluded the perception and experience of the health workers [27][28][29][30].…”

“…Similarly, healthcare seekers' determinants of quality are essential to enable providers to segment healthcare services based on the specific needs of each group in the community. The literature on assessing service quality from consumers' perspectives is scant in Tanzania; most of the available literature focuses on quality drawing from the experience of health workers [28][29][30][31]. Thus, this article partly addressed the gap by explaining the influence of the socio-demographic dimensions on the perceived quality of healthcare service from the experience of the healthcare seekers in the councils of Dodoma City and Bahi District in Tanzania.…”