Introduction: The Star Rating Assessment (SRA) system was established by the Tanzanian government as a method to improve the quality of healthcare. To identify factors influencing SRA implementation, we looked at the deployment of SRA Systems in Kibaha Town and Rufiji District Councils. Methods: To comprehend the experiences of distinct healthcare professionals and Quality Improvement Teams (QITs) on implementation of SRA, we used a descriptive cross-sectional study methodology. Focus Group Discussions (FGDs) and in-depth interviews (IDIs) were used to gather data, which was then evaluated using qualitative content analysis. Results: According to the study’s findings, the majority of group discussion participants were not aware of the SRA system, the QIT members were unaware of their responsibilities for implementing Quality Improvement Plans (QIPs), and the Council Health Management Teams (CHMT) members were not including QIP follow-up in their quarterly supportive supervisions. Shortage of staff, financial resources, insufficient staff training on the SRA system, and insufficient support from CHMT were among the stated difficulties experienced during the deployment of the SRA system. Discussion: The provision of high-quality healthcare in the study sites has improved as a result of the introduction of the SRA system. Nonetheless, there is a need to support healthcare facilities during implementation and provide them with greater training on the standards assessed by SRA.
KeywordsStar Rating AssessmentPrimary HealthcareQuality Improvement PlansQuality of CareTanzania
Aberdeen, T. (2013). Yin, R. K. (2009). Case Study Research: Design and Methods (4th Ed.). Thousand Oaks, CA: Sage. The Canadian Journal of Action Research, 14, 69-71. https://doi.org/10.33524/cjar.v14i1.73
Anasel, M. G. (2017). Family Planning Programme Implementation: Differences in Contraceptive Prevalence Rates across Local Government Authorities in Tanzania. Ph.D. Thesis, University of Groningen. https://research.rug.nl/en/publications/family-planning-programme-implementation-differences-in-contracep
Betts, D., & Cruse, C. (2020). There’s More than One Way to Become a 5-Star Hospital. https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-medicares-hospital-star-rating-system.pdf
Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A Conceptual Framework for Implementation Fidelity. Implementation Science, 2, Article No. 40. https://doi.org/10.1186/1748-5908-2-40
Centers for Medicare & Medicaid Services—CMS (2023). Five-Star Quality Rating System. The U.S CMS, Baltimore, Maryland. https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs
Couper, I., Ray, S., Blaauw, D., Ng’wena, G., Muchiri, L., Oyungu, E. et al. (2018). Curriculum and Training Needs of Mid-Level Health Workers in Africa: A Situational Review from Kenya, Nigeria, South Africa and Uganda. BMC Health Services Research, 18, Article No. 553. https://doi.org/10.1186/s12913-018-3362-9
Creswell, J. W., & Poth, C. N. (2016). Qualitative Inquiry and Research Design: Choosing among Five Approaches. SAGE Publications.
Durlak, J. A., & DuPre, E. P. (2008). Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation. American Journal of Community Psychology, 41, 327-350. https://doi.org/10.1007/s10464-008-9165-0
Eby, L. T. (2003). Book Review: Survey Research Methods, 3rd ed., by Floyd J. Fowler Jr. (2002). Thousand Oaks, Ca: Sage. Organizational Research Methods, 6, 135-138.
English, A., Lanzara, C., Awale, A., & Hatt, L. (2018). Measuring What Matters: Case Studies on Data Innovations for Strengthening Primary Health Care. Primary Health Care Performance Initiative.
Erlingsson, C., & Brysiewicz, P. (2017). A Hands-on Guide to Doing Content Analysis. African Journal of Emergency Medicine, 7, 93-99. https://doi.org/10.1016/j.afjem.2017.08.001
Gage, A. D., Yahya, T., Kruk, M. E., Eliakimu, E., Mohamed, M., Shamba, D., & Roder-DeWan, S. (2020). Assessment of Health Facility Quality Improvements, United Republic of Tanzania. Bulletin of the World Health Organization, 98, 849-858A. https://doi.org/10.2471/BLT.20.258145
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the Framework Method for the Analysis of Qualitative Data in Multi-Disciplinary Health Research. BMC Medical Research Methodology, 13, Article No. 117. https://doi.org/10.1186/1471-2288-13-117
Graneheim, U., & Lundman, B. (2004). Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112. https://doi.org/10.1016/j.nedt.2003.10.001
Kapologwe, N. A., Kalolo, A., Kibusi, S. M., Chaula, Z., Nswilla, A., Teuscher, T., Aung, K., & Borghi, J. (2019). Understanding the Implementation of Direct Health Facility Financing and Its Effect on Health System Performance in Tanzania: A Non-Controlled before and after Mixed Method Study Protocol. Health Research Policy and Systems, 17, Article No. 11. https://doi.org/10.1186/s12961-018-0400-3
Kapologwe, N. A., Meara, J. G., Kengia, J. T., Sonda, Y., Gwajima, D., Alidina, S., & Kalolo, A. (2020). Development and Upgrading of Public Primary Healthcare Facilities with Essential Surgical Services Infrastructure: A Strategy towards Achieving Universal Health Coverage in Tanzania. BMC Health Services Research, 20, Article No. 218. https://doi.org/10.1186/s12913-020-5057-2
Mboya, D., Mshana, C., Kessy, F., Alba, S., Lengeler, C., Renggli, S. et al. (2016). Embedding Systematic Quality Assessments in Supportive Supervision at Primary Healthcare Level: Application of an Electronic Tool to Improve Quality of Healthcare in Tanzania. BMC Health Services Research, 16, Article No. 578. https://doi.org/10.1186/s12913-016-1809-4
Ministry of Health and Social Welfare (2007). Sera ya Afya. https://www.moh.go.tz/storage/app/uploads/public/61b/084/21e/61b08421e2f71055061527.pdf
Mwakatumbula, H. (2021). The Implementation of Direct Health Facility Financing (DHFF): Prospects and Challenges.
National Bureau of Statistics (2010). Tanzania Demographic and Health Survey 2010. National Bureau of Statistics.
Presidents’ Office—Regional Administration and Local Government (2011). Comprehensive Council Health Planning Guidelines. https://hssrc.tamisemi.go.tz/storage/app/uploads/public/5ac/0ae/19e/5ac0ae19e2abc080738188.pdf
Renggli, S., Mayumana, I., Mboya, D., Charles, C., Maeda, J., Mshana, C. et al. (2018). Towards Improved Health Service Quality in Tanzania: An Approach to Increase Efficiency and Effectiveness of Routine Supportive Supervision. PLOS ONE, 13, e0202735. https://doi.org/10.1371/journal.pone.0202735
Ritchie, J., Lewis, J., Nicholls, C. M., & Ormston, R. (2013). Qualitative Research Practice: A Guide for Social Science Students and Researchers. SAGE.
Sirili, N., Frumence, G., Kiwara, A., Mwangu, M., Goicolea, I., & Hurtig, A. K. (2019). “Doctors Ready to Be Posted Are Jobless on the Street…” the Deployment Process and Shortage of Doctors in Tanzania. Human Resources for Health, 17, Article No. 11. https://doi.org/10.1186/s12960-019-0346-8
Smit, B., & Scherman, V. (2021, January 1). Computer-Assisted Qualitative Data Analysis Software for Scoping Reviews: A Case of ATLAS.ti. International Journal of Qualitative Methods, 20. https://doi.org/10.1177/16094069211019140
The Ministry of Health and Social Welfare (2014). Big Results Now Healthcare NKRA Lab. Dar es Salaam. https://pemandu.org/wp-content/uploads/2023/05/TZ-BRN-Healthcare-NKRA-Rev-11-web_English.pdf
The Ministry of Health, Community Development, Gender, Elderly and Children (2016). The National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child & Adolescent Health in Tanzania (2016-2020): One Plan II. https://www.globalfinancingfacility.org/sites/gff_new/files/documents/Tanzania_One_Plan_II.pdf
The Ministry of Health, Community Development, Gender, Elderly and Children (2017a). National Supportive Supervision Guidelines for Quality Health Services. Health Quality Assurance. https://roryadc.go.tz/storage/app/uploads/public/626/a67/b7a/626a67b7aa8fe699990192.pdf
The Ministry of Health, Community Development, Gender, Elderly and Children (2017b). Star Rating Assessment Report 2017.
The Ministry of Health, Community Development, Gender, Elderly and Children (2018). Star Rating Assessment Reports. Health Quality Assurance.
United Republic of Tanzania (1999). The Tanzania Development Vision 2025. President’s Office. http://www.tzonline.org/pdf/theTanzaniadevelopmentvision.pdf
United Republic of Tanzania (2017). Direct Health Facility Financing Guide.
Vasileiou, K., Barnett, J., Thorpe, S., & Young, T. (2018). Characterising and Justifying Sample Size Sufficiency in Interview-Based Studies: Systematic Analysis of Qualitative Health Research over a 15-Year Period. BMC Medical Research Methodology, 18, Article No. 148. https://doi.org/10.1186/s12874-018-0594-7
Wright, J. (2015). Health Finance & Governance Project. Essential Package of Health Services Country Snapshot: Tanzania. Bethesda, MD: Health Finance & Governance Project, Abt Associates Inc. https://www.hfgproject.org/essential-package-of-health-services-country-snapshot-tanzania/
Yahya, T., & Mohamed, M. (2018). Raising a Mirror to Quality of Care in Tanzania: The Five-Star Assessment. The Lancet Global Health, 6, e1155-e1157. https://doi.org/10.1016/S2214-109X(18)30348-6