Assessing a Community-Based Quality Management Approach

Research Overview

The Expanded Quality Management Using Information Power (EQUIP) project was implemented from 2011 to 2014 in Tanzania and Uganda. The project’s goal was to link the health system with communities in order to generate data-driven interventions to improve maternal and newborn health. Quality improvement activities were implemented at three levels: district, health facility, and community. Preliminary findings indicate large increases in institutional delivery in both Tanzania and Uganda, as well as positive changes in newborn care practices and increased awareness of life-threatening complications. TRAction is supporting a case study in order to examine how community-based quality improvement approaches may contribute to improving recognition of and care seeking for maternal and newborn complications within the context of the EQUIP project.

Project Location

Tanzania: Mtwara Region, Tandahimba and Newala Districts

Uganda: Busoga Region, Mayuge and Namaingo Districts

Research Objectives

The aim of this study is to identify factors that influence illness recognition and care-seeking. Research questions include:

• What was the process of illness recognition and care seeking for mothers and newborns?
• What was the sequence of actions for care seeking?
• How did the intervention impact care seeking?
• How do demographic factors influence care seeking?

Study Approach

The study used a mixed methods design in order to assess whether the EQUIP project has resulted in improvements in recognition and appropriate care-seeking for maternal and newborn complications.  Qualitative data was collected through in-depth interviews, group interviews, and focus group discussions with affected women and their families, community members, and women’s groups. Quantitative methods were used to gather information about the local context, including epidemiological data and the geographic profile of the study area. In addition, EQUIP project facility readiness data was used to assess the quality and availability of care at the facilities. Comparisons were made between the intervention and control areas in order to document the impact of the intervention on recognition and care seeking.

Key Findings

Most respondents seemed to recognize symptoms of most newborn and maternal complications. Influencers for recognition included, re-occurrence of the symptoms, severity of the condition, previous knowledge of the illness and recognition from the family member. In care seeking, results show that there is high reliance on primary care facilities. There was different care seeking patterns for both cases: care is usually sought at health facilities of various levels and sometimes at home. Care seeking was reported to be influence by perception of the causes of the illness, including medical, biological, and traditional causes. Other influencers for care seeking and care seeking patterns include beliefs that health facilities provide better services and lack of treatment from one facility prompted the family to access another facility. With regards to decision making, husbands were reported to play a key role especially in providing financial support and accompanying the woman to the facility for maternal complications. Other family members were also reported to play a role if the husband was not present, including female relatives, aunts, sisters in-law, grandmothers, and traditional birth attendants.     

Lessons Learned

Findings show that the ongoing maternal, newborn and child health interventions increased uptake of care in the study area. The findings also show the failure of the system to meet the demand for health care services is due to lack of capacity in treating newborn illness and maternal complication, especially in primary health care facilities. Lack of skilled staff and lack of medical supplies and equipment were also reported to be a barrier in accessing optimal care for most of the respondents.   Poor families were also reported to be at a disadvantage in accessing health care due to the high cost of treatment and costs for transport if they have to travel to seek care at the tertiary level facilities. Community education is reported to be an important aspect in educating mothers and other community members on essential maternal and newborn care. Community support systems emerged as an important component for accountability issues and in helping poor families to access funds to meet their health needs.

Research into Action

This case study identified the factors influencing care seeking for maternal and newborn complications. Findings will be shared with district managers in Uganda and Tanzania in order to guide future efforts to reduce newborn and maternal death. In addition, TRAction will synthesize the findings from this and four other recognition studies in order to facilitate understanding of community-oriented approaches for improving recognition of and care seeking for maternal and newborn complications. Experience from this study will be used to inform the development of community-oriented approaches for addressing maternal and newborn health in low and middle income countries.

Research Partners

Project Status