From policy to practice: A quality improvement approach improves antenatal care services in Tanzania

Although antenatal care (ANC) attendance is high in Tanzania, with 94% of pregnant women receiving at least one ANC visit and 62% receiving four or more visits , there is a need to focus the care that ANC clients receive to improve health outcomes for mothers and newborns. To address this need, the Ministry of Health and Social Welfare (MOHSW) adopted Focused Antenatal Care (FANC) as a policy in 2000. FANC serves as a platform for such vital services as intermittent preventative treatment to prevent malaria in pregnancy. JHPIEGO, through USAID's ACCESS Program, is working with the MOHSW to put this policy into practice by training ANC providers nationally in FANC and orienting them to a quality improvement approach. Using this approach, ANC providers continually assess and improve ANC services by applying performance standards. Since 2005, 64 facilities have conducted baseline assessments of ANC services and 15 facilities have completed follow-up assessments. At baseline, facilities achieved a mean score of 42.1% (median of 40.5%), while at the first followup, facilities' mean score was 60.8%. This increase is due to steps taken by facility staff to identify and address gaps in the quality of services, such as implementing infection prevention practices Additional assessments are planned for 2007, with the target for all facilities to ultimately achieve at least 80% of the standards. Discussion will include steps taken to ensure that national policy on FANC moved rapidly into improved performance at health facilities, and how other programs might apply these lessons learned.