Understanding and enhancing approaches to quality improvement in small and medium-sized private facilities in Tanzania

Effect of approaches to quality improvement in small and medium-sized private facilities: A randomised controlled trial in Tanzania

Status

Active, not recruiting

Phases

Unknown

Study type

Interventional

Source

ISRCTN

Registry ID

ISRCTN93644888

Enrollment

240

Registered

2016-03-09

Start date

2016-03-14

Completion date

Unknown

Last updated

2024-07-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

1. Clinical quality of care 2. Business performance Not Applicable 1. Clinical quality of care 2. Business performance

Interventions

Participating health facilities are randomly allocated to one of two groups. Intervention group: Health facilities are assessed at two points in time (baseline and then one to two years later) using

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: Inclusion criteria for health facilities: 1. Those operating within the study zones 2. Those operating under the umbrella organisations of APHFTA (Association of Private Health Facilities in Tanzania) and CSSC (Christian Social Services Commission)

Exclusion criteria

Exclusion criteria: Exclusion criteria for health facilities: 1. Does not operate within the study zones 2. Does not operate under the umbrella organisations of APHFTA (Association of Private Health Facilities in Tanzania) and CSSC (Christian Social Services Commission) 3. Provides mental health services only 4. A referral hospital

Design outcomes

Primary

Measure	Time frame
Current Primary Outcome Measures (as of 17/01/2018): 1. Correct treatment measured 18-24 months after the start of the intervention using standardised patients presenting four cases (suspected malaria, tuberculosis, asthma, and upper respiratory tract infection). 2. Compliance with infection prevention and control practices measured 18-24 months after the start of the intervention using observations of health worker-patient interactions Previous Primary Outcome Measures: Technical quality of patient care is measured two years after the start of the intervention in each health facility by: 1. Trained professionals present themselves unnanounced to a health provider as a genuine patient (the health providers are unaware that the standardised patient is acting) 2. Role-playing clinical vignettes (involving a fieldworker role-playing as a patient) 3. Observing doctor-patient interactions to assess patient safety and infection control practices using a structured questionnaire	—

Measure

Time frame

Current Primary Outcome Measures (as of 17/01/2018): 1. Correct treatment measured 18-24 months after the start of the intervention using standardised patients presenting four cases (suspected malaria, tuberculosis, asthma, and upper respiratory tract infection). 2. Compliance with infection prevention and control practices measured 18-24 months after the start of the intervention using observations of health worker-patient interactions Previous Primary Outcome Measures: Technical quality of patient care is measured two years after the start of the intervention in each health facility by: 1. Trained professionals present themselves unnanounced to a health provider as a genuine patient (the health providers are unaware that the standardised patient is acting) 2. Role-playing clinical vignettes (involving a fieldworker role-playing as a patient) 3. Observing doctor-patient interactions to assess patient safety and infection control practices using a structured questionnaire

—

Secondary

Measure	Time frame
Current Secondary Outcome Measures (as of 17/01/2018): 1. Perceived quality of care is measured using patient exit interviews at 18-24 months 2. Facility caseload is measured using the health facility questionnaire at 18-24 months 3. Facility revenue is measured using the health facility questionnaire at 18-24 months 4. User fees paid is measured using the standardised patients and patient exit interviews at 18-24 months 5. SafeCare assessment score is measured using the SafeCare assessment tool implemented by PharmAccess at baseline and at 18-24 months 6. Management practices score is measured in two different ways using: i) the health facility questionnaire at 18-24 months; ii) a sub-set of management-related criteria in the SafeCare assessment tool implemented by PharmAccess at baseline and at 18-24 months 7. History taking & examination, diagnosis, unnecessary and harmful care, dosing and advice measured using standardised patients at 18-24 months 8. Compliance with infection prevention and control practices by domain (hand hygiene, injection and blood draw safety, personal protective equipment safety, disinfection of reusable medical devices, and waste segregation) measured at 18-24 months using observations of health worker-patient interactions Previous Secondary Outcome Measures: 1. Perceived quality of care is measured using exit interviews at two years 2. Facility caseload is measured using the health facility questionnaire at baseline and two years 3. Facility revenue is measured using the health facility questionnaire at two years 4. User fees paid is measured using the standardised patients at two years 5. Quality of management is measured using the hospital management tool at two years 6. SafeCare assessment score is measured using the SafeCare assessment tool implemented by PharmAccess at baseline and two years	—

Measure

Time frame

Current Secondary Outcome Measures (as of 17/01/2018): 1. Perceived quality of care is measured using patient exit interviews at 18-24 months 2. Facility caseload is measured using the health facility questionnaire at 18-24 months 3. Facility revenue is measured using the health facility questionnaire at 18-24 months 4. User fees paid is measured using the standardised patients and patient exit interviews at 18-24 months 5. SafeCare assessment score is measured using the SafeCare assessment tool implemented by PharmAccess at baseline and at 18-24 months 6. Management practices score is measured in two different ways using: i) the health facility questionnaire at 18-24 months; ii) a sub-set of management-related criteria in the SafeCare assessment tool implemented by PharmAccess at baseline and at 18-24 months 7. History taking & examination, diagnosis, unnecessary and harmful care, dosing and advice measured using standardised patients at 18-24 months 8. Compliance with infection prevention and control practices by domain (hand hygiene, injection and blood draw safety, personal protective equipment safety, disinfection of reusable medical devices, and waste segregation) measured at 18-24 months using observations of health worker-patient interactions Previous Secondary Outcome Measures: 1. Perceived quality of care is measured using exit interviews at two years 2. Facility caseload is measured using the health facility questionnaire at baseline and two years 3. Facility revenue is measured using the health facility questionnaire at two years 4. User fees paid is measured using the standardised patients at two years 5. Quality of management is measured using the hospital management tool at two years 6. SafeCare assessment score is measured using the SafeCare assessment tool implemented by PharmAccess at baseline and two years

—

Countries

Tanzania

Contacts

Public ContactCatherine Goodman

Catherine.Goodman@lshtm.ac.uk+44 20 7636 8636

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Feb 21, 2026