Under-resourced government health systems in sub-Saharan Africa often provide poor quality services. How can policy-makers improve healthcare standards without unsustainable increases in expenditure? The Tanzania Family Health Project implemented a range of interventions involving staff, facilities and services in the Mbeya region. Within two years, substantial progress has been made.

The Mbeya region in the Southern Highlands of Tanzania has a population of around two million people. The government and non-governmental organisations provide health services in rural areas, while the private sector is growing in urban communities.

Managerial, organisational and financial reforms are needed in the public sector. The Tanzania Family Health Project, jointly funded by the Government of Tanzania and the UK Department for International Development, aims to improve access to high quality integrated family health services.

Health managers have developed a package of interventions to improve service quality. These cover three broad areas:

• Staff factors - continuing education in clinical skills, training in service quality concepts, strengthened management systems, enhanced community links.
• Facility factors - upgraded health facilities, community participation, regular provision of supplies and drugs.
• Service factors - regular management meetings, integration of all curative and preventative services, quality assurance monitoring, broader service provision in the private sector.

A mid-term evaluation of the project showed:

• a nine-fold increase in the provision of treatment services for sexually transmitted infections
• doubling of the number of users of family planning services
• high levels of staff trained in reproductive healthcare
• improved health infrastructure including building maintenance and supplies of equipment and consumables
• enhanced patient satisfaction
• increased community involvement in health service issues and the development of community health plans
• revised and improved management and supervision systems.

The estimated cost of these interventions is nine dollars per capita over a five-year period. This includes significant technical support that would not be needed on a long-term basis. If the project is successful, however, demand for contraceptives and antibiotics will increase. These costs are currently met by donors, but financial sustainability must be addressed in the long-term.

The experience of the Tanzania Family Health Project shows that it is possible to significantly raise the quality of health service provision at a modest cost. This process is facilitated by:

• strong local commitment and leadership
• additional financial resources from reforms such as taxation, social insurance schemes, user fees or increased public investment in social sector spending
• structural changes including the establishment of district health boards and the revision of procedures for accounting, transport, logistics and information management
• establishing a culture of quality assurance.

Source(s):
'Improving service quality: experience from the Tanzania Family Health Project' by F. Atherton, G. Mbekem and I. Nyalusi, International Journal for Quality in Health Care 11 (1999)

Funded by: UK Department for International Development

id21 Research Highlight: 7 September 2001

Further Information:
Frank Atherton
DFID (Bangladesh)
FCO
King Charles Street
London SW1A 2AH
UK Tel: +880 2882705

Fax: +880 2883474
Contact the contributor: f-atherton@dfid.gov.uk

Department for International Development, UK

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