Business of Quality in health care
BOQ project commonly known as Safe Care-project is among the projects implemented by PRINMAT since November 2015 in collaboration with Pharm Access International through HDIF funding. The project intends to improve quality of services at PRINMAT facilities. Phase one inclusion was 20 facilities in lake zone and phase two another 20 facilities are expected to be added from lake zone and southern zone. Phase two is about to start on November 2016. Success story for phase one implementation is displayed herewith.
Paragraph 1: Background
The Private Nurses and Midwives Association of Tanzania (PRINMAT) supports establishment of Maternity Homes in rural and semi-urban areas so as to improve access to reproductive health services.It is mandated by the Ministry of Health to facilitate the licensing processand ensure quality of services in Maternity Homes. At organizational level,PRINMAT envisions maternity homes as centers that provide best quality services inorder to attract community members to seek service”.gf
PRINMAT has undertaken initiatives to improve quality ofservices in Maternity Homes in collaboration with stakeholders.Most of these efforts have followed avertical approach, addressing specific components of service delivery. Lack of approved facility-wide standards to measure quality has madeit difficultto objectively compare quality performance between MaternityHomes. Furthermore, experience shows the need to guide these facilities to prioritize addressing key quality gaps. Recently, PRINMAT in collaboration with PharmAccess have adopted the SafeCareapproach to launch a stepwise, facility-wide quality improvement methodology that builds ownership in the improvement process.
Paragraph 2: Actions taken
Using the SafeCaremethodology, PRINMAT has carried out quality assessment of 20 Maternity Homes whereby a prioritized Quality Improvement Plan (QIP) is developed. The QIP puts into consideration patient safety and availability of resources. The facility owns and implement the QIP while PRINMAT provides regular technical support. The approach has been an eye opener to PRINMAT and greatly appreciated by the facility owners as testified below.
Owners appreciate the value of the approach as it makes them realize what they had not considered as important components of care delivery: One facility Manager commented that,‘When you came for assessment and asked for staff files, I was shocked what to give, and it took me sometime to trace the needed staff information, but now everything is in order’
Owners are committed to addressing the prioritized improvements: During dissemination of the Quality Improvement Plan (QIP), one Manager from Sengerema said,‘As the days go on, I see the SafeCare efforts will lead to real change, as providers are now attentive towhat is right compared to the past’.
Immediately after the assessment, a facility in Mwanza,started renovations to address client flow. When the manager was asked why now? she responded: “when I reflect on what I did wrong before the SafeCare assessment, some of which do not need money, that’s why I change them to avoid similar mistakes in the future and promote quality’.
The client needs are being recognized: Patient rights and privacy were also compromised before to some extent. One manager from Tarime-Mara said‘I did not know if patient rights creed needed to be displayed, and what are they for’
Going forward, PRINMAT believes that adopting the SafeCaremethodology, puts it in a betterposition to monitor, support and ensure qualityservice deliveryby member facilities. For the first time we have undertaken a comprehensive approach to evaluate quality of services. Using the SafeCare tools we have now a comprehensive approach and we are now looking atservice related areas we did not do before. For example,we are now able to link during a single assessment how facility management, adherence to best practices both in staff management and in clinical servicesand infection control and prevention influences quality of service.It also provides PRINMAT with a structured tool to support its members as they undertake the journey towards improving quality of their service.
The approach strengthens PRINMAT’scapability to achieve its envisioned mission of assuring quality of services and making Maternity Homes to become centers that attract community members for MNCH services. This will greatly complement the Government’ efforts to reduce Maternal, Infant and Child Mortality in the country.