Jaribu Jennie, Penfold Suzanne, Manzi Fatuma, Schellenberg Joanna, Pfeiffer Constanze
Swiss Tropical and Public Health Institute, Basel, Switzerland Basel University, Basel, Switzerland Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2016 Sep 22;6(9):e010317. doi: 10.1136/bmjopen-2015-010317.
To describe health workers' perceptions of a quality improvement (QI) intervention that focused on improving institutional childbirth services in primary health facilities in Southern Tanzania.
A qualitative design was applied using in-depth interviews with health workers.
This study involved the Ruangwa District Reproductive and Child Health Department, 11 dispensaries and 2 health centres in rural Southern Tanzania.
4 clinical officers, 5 nurses and 6 medical attendants from different health facilities were interviewed.
The healthcare providers reported that the QI intervention improved their skills, capacity and confidence in providing counselling and use of a partograph during labour. The face-to-face QI workshops, used as a platform to refresh their knowledge on maternal and newborn health and QI methods, facilitated peer learning, networking and standardisation of care provision. The onsite follow-up visits were favoured by healthcare providers because they gave the opportunity to get immediate help, learn how to perform tasks in practice and be reminded of what they had learnt. Implementation of parallel interventions focusing on similar indicators was mentioned as a challenge that led to duplication of work in terms of data collection and reporting. District supervisors involved in the intervention showed interest in taking over the implementation; however, funding remained a major obstacle.
Healthcare workers highlighted the usefulness of applying a QI approach to improve maternal and newborn health in rural settings. QI programmes need careful coordination at district level in order to reduce duplication of work.
描述卫生工作者对一项质量改进（QI）干预措施的看法，该干预措施旨在改善坦桑尼亚南部初级卫生设施中的机构分娩服务。
采用定性设计，对卫生工作者进行深入访谈。
本研究涉及坦桑尼亚南部农村地区的鲁安瓜区生殖与儿童健康部门、11家诊疗所和2家卫生中心。
来自不同卫生机构的4名临床干事、5名护士和6名医护人员接受了访谈。
医疗服务提供者报告称，QI干预提高了他们在分娩期间提供咨询和使用产程图的技能、能力和信心。面对面的QI研讨会作为一个平台，用于更新他们关于孕产妇和新生儿健康以及QI方法的知识，促进了同伴学习、交流和护理提供的标准化。医疗服务提供者青睐现场随访，因为这让他们有机会获得即时帮助，学习如何在实践中执行任务，并被提醒所学内容。提到实施侧重于类似指标的并行干预是一个挑战，导致在数据收集和报告方面出现工作重复。参与干预的地区监督员表示有兴趣接管实施工作；然而，资金仍然是一个主要障碍。
卫生工作者强调了应用QI方法改善农村地区孕产妇和新生儿健康的有用性。QI项目需要在地区层面进行仔细协调，以减少工作重复。
