Functionality of Quality Improvement Teams in Primary Healthcare Facilities in Tanzania: Findings from Star Rating Assessment

Abstract

Background: A strong primary healthcare (PHC) system is essential for achieving universal health coverage (UHC). The coronavirus disease 2019 (COVID- 19) effects in health systems have reminded us on the importance of strengthening PHC. Quality of services is an integral component of UHC that requires strong governance and leadership. This study aims to assess functionality of Quality Improvement Teams (QITs) in PHC facilities in the context of Star Rating Assessment (SRA). Methods: This is a quantitative secondary data analysis using the SRA re-assessment data collected in the fiscal year 2017/18. QITs functionality was measured by desirable performance of four (4) indicators namely availability of the QITs, regular meeting of QITs, quarterly meetings and self-internal assessment conducted. The proportions were compared by using chi square test. Prevalence ratios were estimated by multivariate Poisson regression poisson regression model with 0.05 as a level of significance. Results: This study involved 5933 PHC facilities majority of which were dispensaries (87.6%), rural located (78.3%) and public owned (77.2%). On average, 22.5% of QITs were functional. Urban located health facilities were 13% more likely to have functional QITs compared to rural located ones (APR = 1.13, p = 0.06), health facilities with satisfactory availability of human resource for health were 29% more likely to have functional QITs (APR = 1.29, P < 0.001), health facilities with functional Health Facility Management Teams were about 3 times likely to have functional QITs (APR = 2.86, P < 0.001). Moreover, health facility level was not a good predictor of QITs functio nality whereby health centers were 35% more likely to have functional QITs ( p = 0.21) while dispensaries were 20% less likely to have functional QITs compared to district hospitals ( p = 0.35). Conclusions: Non functionality of QITs is a challenge in PHC facilities in Tanzania. The challenge is more pronounced in rural located PHC facilities. Measures are to be taken to enhance QITs functionality in these facilities.