Effects of a Quality Improvement Program on Antenatal Care in 12 Regions of Tanzania

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: World Health Organization guidelines for focused antenatal care (ANC) recommend a minimum of four ANC visits during pregnancy. From 2008-2014, the Mothers and Infants, Safe, Healthy, Alive (MAISHA) program collaborated with the Tanzanian Ministry of Health to improve quality of ANC to reduce maternal and newborn mortality. ANC providers and supervisors received clinical and supervision skills training and a quality improvement approach with quarterly monitoring and planning to bridge gaps in quality of care was institutionalized.

Methodology: A facility survey was conducted in 12 regions to assess the quality of ANC services using direct observations, facility inventories, record reviews, and health worker knowledge assessments. It employed a pre/post design with data collected in 2010 and 2012.

Results: In 2012, improvements were evident in the provision of preventive care: 83% of women received iron or folic acid at their first visit, 77% received tetanus toxoid injections, and 76% received vouchers for insecticide-treated nets. Nominal increases were noted in the proportion of clients who received counseling and testing for HIV at their first ANC visit (6%), blood pressure screening (5%), and intermittent preventive treatment for malaria (two doses, 3%). Counseling declined for iron/folic acid, primarily at regional hospitals, with only 10–18% of ANC clients receiving such counseling. Slight improvements in counseling on tetanus toxoid, anti-malarials and danger signs were noted, including: severe headaches /blurred vision (37% increase), vaginal bleeding (23% increase) and severe abdominal pain (18% increase).

Conclusion: Findings suggest the MAISHA interventions contributed to improvements in key evidence-based components of ANC, while a few gaps in quality of counseling remained. Greater improvements in quality at lower-level health facilities were achieved than regional hospitals, suggesting a need for renewed emphasis on counseling in pre-service and in-service training and during supervision/mentorship visits at those hospitals.