1. Outline

2. Content Chapter 1: Background and Quality Improvement (QI) achievements Chapter 2: Situation Analysis Chapter 3: Strategic Quality Improvement Priorities Chapter 4: Resource Requirements Chapter 5: Finance Plan Chapter 6: Implementation Framework 6.5Phased action plan Chapter 7: Monitoring and Evaluation Chapter 8: Conclusion References 2 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

3. Background and achievements Reviewed Tanzania Quality Improvement Framework place Tanzania Quality Improvement Forum has set momentum Quality Supportive policies Quality Improvement Organizational set up is evolving Hospital Infection Prevention and Control standards developed and tested National AIDS Control Programme quality in Care and Treatment Clinic s and Prevention of Mother To Child Transmission Laboratory and other diagnostics standards 3 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

4. Current Situation Ante-Natal Care (ANC) coverage by skilled provider 96% Births assisted by a skilled provider 51% Births delivered in a health facility 50% Fully vaccinated children 75% Prevention of Mother To Child Transmission coverage 78.6% of all ANC services Mean duration (months) exclusive breastfeeding 2.4 Children who slept under an Insecticide Treated Nets the night before the survey 64% Among children with fever, per cent who received antimalarials same or next day 41% 4 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

5. Current situation ctd Infection Prevention and Control and Hospitals and laboratory standards in place; need complete set Comprehensive supportive supervision and mentoring for HIV/AIDS manual and training tool; need to go beyond HIV/AIDS Indicators for Quality Improvement – evolving; need full set Shortfalls at assessments – Staff knowledge, drugs and equipment, Central Sterile Supplies Department, safety, practices 5 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

6. Lessons Various Quality Improvement approaches have possibilities for synergy Plan-Do-Study-Act is applied in common to get to solutions and revisit effects Evidence based approach is an integral part Optimizing currently stocked resources is key Working environment improvement can also shape the mindset Practical applications in HIV/AIDS, Infection Prevention and Control and Health Care Waste present local learning opportunities 6 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

7. Major Challenges Program Harmonization/ Integration of approaches Process Reaching Every District (RED) and Every Facility (REF) with mentoring, coaching for problem- solving Clients Clients education on rights and obligations Providers Uplifting staff morale and productivity Deployment and retention 7 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

8. Strategy Goals G.1Client and provider rights and obligations are attained at optimal level with maximum use of available resources. G.2Safety of services, procedures and working environment is attained for the benefit of clients and care providers. G.3Optimal quality is achieved and sustained in clinical, diagnostic, nursing and other allied care. G.4An integrated Quality Improvement program established that shall contribute to improved health facility working processes and systems for the benefit of clients G.5Stepwise certification towards accreditation system functioning based on objective independent assessments G.6Quality Improvement incorporated in all pre-service and in-service training programs for health workers. Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania8

9. Strategy Framework Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania9

10. Strategic areas (priorities) A:To enhance client focus in service delivery B: To increase patient and staff safety. C: To improve clinical, diagnostic and nursing CARE D: To improve management systems and accountability E: To enhance evidence for Quality Improvement (QI) F: To put in place a catalytic system for applications of QI methods and tools country wide Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania10

11. Strategic QI priority A:To enhance client focus in service delivery  Clients communication and handling  Client complaints handling procedures  Inform clients and care providers on Patient’s Charter and Code of Ethics  Informed-consent for medical and surgical procedures  Accountability to clients and communities  Strengthen Quality Improvement procedures for home based care 11 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

12. Strategic priority B: To increase patient and staff safety.  Functional equipment, safe and potent medicines and supplies  Consolidate and sustain clean and organized working environment; address infrastructure standards and Planned Preventive Maintenance  Consolidate gains made in Health Care Waste Management  Establish a critical incident reporting system for use at all hospitals and health centers  Consolidate gains made in Infection Prevention and Control 12 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

13. Strategic priority C: To improve clinical, diagnostic and nursing practice (CARE)  Check for availability and use of case management protocols and nurses Standard Operating Procedures  Undertake periodic care practices and prescriptions audit surveys  Transparent management of obstetric, pediatric, medical, surgical, and nursing errors  Ensure availability of functional equipment for hospital outpatients, inpatients and surgical cases 13 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

14. Strategic priority C ctd  Check and report on regularity in availability of supplies (medicines, delivery packs, vaccines, safe blood and blood products)  Maintain high standards of diagnostic services Clinical/surgical NursingDiagnostic 14 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

15. Strategic priority D. To improve management systems and accountability  Promote innovation in leadership for Quality Improvement (QI)  Capacitate RHMTs, CHMTs, and health facility Quality Improvement Teams in comprehensive supportive supervision (couching & mentoring)  Develop and disseminate integrated QI implementation guidelines and harmonized tools for QI work  Collaborate with health systems experts to address health systems issues affecting QI 15 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

16. Strategic priority E: To enhance evidence for Quality Improvement  Quality Improvement (QI) related research and assessments; operational research capacity at facilities  Learning from best practices of QI  Patient records and health information  Standards and indicators for assessments,  Indicators for Monitoring and Evaluation 16 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

17.  Establish and manage a Quality Improvement (QI) operational research support fund  Widen scope of, and participation in QI forum  Liaise with business community to set in motion competitions and awards for QI  Put in place a pooled fund to support QI capacity development and QI innovations  Incorporate QI into all pre-service and in- service training programs for health workers 17 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania Strategic priority F: To put in place a catalytic system for applications of QI methods and tools country wide

18. Caps 4,5, 6, and 7 Resource requirements (4), Financing (5) and Implementation framework (6) are pointers to feasibility and sustainability of the strategy. Cap 7: Mid term review and end of term evaluation shall be carried out using a mixed team of external and internal evaluators. On annual basis progress of the quality improvement initiative shall be reported at the Annual Joint Health Sector Review as an integral part of the National Health Profile. 18 Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania

19. ASANTENI SANA Dr. Henock Ngonyani MD, MPH - Assistant Director - Health Services Inspectorate & Quality Assurance Section - MoHSW Tanzania19