1. Hildegalda P. Mushi and Dr Sudai, Boniphace Marwa Presented on 5th National Quality Improvement Forum on Health and Social Welfare 28 th August 2015, Hyatt Regency Hotel Dar es Salaam Utilization of Indicator-Based Assessment Methodology for Quality Improvement in Health care services in Tanzania; experience from the Southern regions

2. Outline Background Objective The tool – structure Methodology Results Discussion and recommendations Conclusion

3. Background In 2013, indicators were developed from existing national and international standards Consultative approach among internal and external experts Data collecting tools were also developed consultatively Designed to be a facility owned process of assesement, followed by prioritized action plans

4. Objective To share the outcome of utilization of an indicator based framework in measuring change in quality of health care services

5. ...Cont‘d Measuring quality using indicators developed by Tanzanian experts with the following instruments 1. Self Assessment (SA)-filled out by Facility Manager 2. Patient Questionnaire (PQ) 3. Staff Questionnaire (SQ) 4. Facilitator Checklist (FC) 5. Facility Manager Interview Guide (FI)

6. Structure of the tool Domain Clinical care Dimension Neonatal care Indicator Health staff is trained at least once a year on neonatal resuscitation Item Is health staff trained on neonatal resuscitation at least once a year?

7. Methodology Quantitative and Qualitative methods surveys from hospital clients (staff and patients) and a focused interview that involved hospital managers Data were collected, entered and analyzed using TIBAS - an excel adapted tool for processing the data and produce reports The report is shared to hospital management, the QITs and other staff Using the assessment results for quality improvement action plans in the hospital

8. Self- assess- ment 1 Staff - survey 3 Patient - survey 2 Check- list 4 Team- session & feed- back Inter- view w/ FMT 5 Health Facility visit by Quality Facilitator People Communication Quality & Safety Management Clinical Care On the job training Peer-to- peer visits Coaching by trained coaches Continous Quality Improvement Plan Summary of Assessment tools, health care domains and QI mechanisms used to sustain good practices

9. Results Re-assessment results from all domains improved Domains of clinical care and quality and safety had greater improvement than others Maximum points scored was 17.3 (the difference of points between first and second assessment in a particular hospital) and the minimum points scored was 2.71 and the average increment scores points is 9.70. The highest hospital score in the first assessment was 63% and the lowest was 51%; Second assessment, the highest score was 74% and the lowest score was 59%.

10. Hospital A Hospital BHospital C Domain Dimension201420152014201520142015 Quality and safety Quality and Safety CIRS3162.82885.93981.5 Infection Control4672.44561.75081.9 Laboratory7161.57491.79085.4 Waste Managmt3973.96269.65269.6 AVERAGE46.7567.652.274.557.7579.6 Clinical Care ANC4592.465895591.5 Delivery6079.26487.97370.6 Family Planning7986.62142.48074.4 Neonatal care5687.19190.59691.7 PMTCT8280.57689.58887.3 Post natal10098.510084.575100 AVERAGE70.3385.869.583.877.8385.9 Management Leadership and Governance7147.47142.76450 Amenities58616660.36956.4 Data2457.53642.55452 Medicine7976.67177.75374.9 Emergencies714.11663.96288.8 Equipment5373.37673.35386.7 Finance8166.66767.18287 Guidelines22805365.78386.7 Human Resource7081.66147.45674.3 Maintanance341.16685.74053.6 Supplies298.66814.55179.3 AVERAGE45.1859.2 58.260.6371.8 Table of results for some hospitals and domains

11. Discussion Indicator based assessment is reliable and valid method due to its objectivity, sensitivity to change and scientific approach to improving quality Indicators of clinical care and quality and safety improved significantly because they can be seen by all players (staff, client and managers) Most of improvement involved purchasing of IPC materials, ensure availability of missed items etc Other domains are more managerial and can hardly be visualized or felt by other players. Need managers commitment and positive attitudes

12. …. Cont’d Revival of QITs and WITs have contributed to improvement Regular internal quality meetings and follow ups of planned tasks (monthly) The method is easy and cheap Adapted to the health system of the hospital Active participation of QIT/hospitals lead to ownership of results and improvement plans Sustainable –using available resources

13. Recommendation Wider application of indicator based assessment is recommended due to its objectivity, inclusivity and sensitivity to change. Systematic QI mechanisms e.g internal assessment, OJT, peer visits, coaching and mentorship, documentation of good practices is highly encouraged to sustain the best practices

14. Conclusion Indicator based assessment is the reliable, valid and sensitive tool for measurement of health care services delivery

15. Thank you