Background: In Tanzania, maternal and newborn health outcomes have been slow to
improve. The Expanded Quality Management Using Information Power (EQUIP)
project was carried out in Tandahimba district from November 2011–April 2014.
EQUIP engaged village volunteers in quality improvement processes in which they
problem-solved around key issues related to maternal and newborn health in their
communities. Examples of community-level quality improvement are rare and there is
little documentation of these.
Aim: To explore the implementation of community-level quality improvement in-depth,
identifying its facilitators and barriers; to analyse community-level quality improvement
within the context of community participation; to determine influencers of birth
preparedness and health facility delivery; and to evaluate user perspectives around
perceived quality of maternal and newborn health care.
Methods: A mixed-methods process evaluation in four villages (November 2012–
November 2013). A continuous household survey provided quantitative data around
household behaviours and perceived quality of care.
Results: Mentoring and coaching were required to strengthen volunteer capacities to do
quality improvement. Support from village leaders, regular volunteer education, and use
of local data were key facilitators of the intervention. Community participation was high
with some indication of empowering processes. Volunteer-targeted practices like birth
preparedness and health facility deliveries were carried out by a majority of women
(95% and 68% respectively). Common reasons for these practices included education
around their importance from multiple sources; feeling that making birth preparations
would positively impact care received; and male involvement. Qualitative data
highlighted instances of disrespectful or abusive care, suggesting improvements in
quality of care are still needed.
Conclusion: Village volunteers readily participated in EQUIP. With support, volunteers
were able to use quality improvement to contribute positively to changing care-seeking
and other behaviours around maternal and newborn health. However, improvements in
care-seeking must be accompanied by improvements in quality of care.