Improving service quality: experience from the Tanzania Family Health Project.

OBJECTIVE To improve the quality and uptake of reproductive health service in rural communities in Tanzania. DESIGN Descriptive study of operational research. SETTING One and a half million people living in urban and rural communities in the Mbeya Region of Tanzania. METHOD Design and implementation of a range of service quality improvement measures. INTERVENTIONS Management systems strengthening; clinical skills training; orientation of health staff to service quality; introduction of quality assurance systems; improvement to supervision systems; community involvement in monitoring health service delivery. OUTCOME MEASURES Health service utilization rates; client perceptions of health service quality; situation analysis of health service provision. RESULTS Uptake of reproductive health services increased; improved client perceptions of service quality; improved health infrastructure; increased community participation in health service management. CONCLUSIONS Health service quality in sub-Saharan Africa can be improved substantially through a process of identifying and addressing the constraints which militate against effective service provision. The cost of such improvement is modest compared with current health expenditure. Health planners and managers involved in sectoral reform programmes should give due attention to quality assurance mechanisms in addition to structural elements of the reform process.