OUR VOICE, OUR HEALTH

A community feedback system to improve health services
Tanzania

Background

Delivering high quality health services is a critical component of achieving Sustainable Development Goal 3, which aims to promote good health and well-being worldwide. Poor health services lead to high mortality, high morbidity, diminished economic productivity, and eventually to poverty. In order to combat these ill effects, Tanzania, with a population of over 50 million people, has implemented a number of plans to expand health services (Vision 2025, Health Sector Reform, Health Sector Strategic Plan III, Primary Health Services Development Program, etc.), but in addition to the quantity of healthcare available, the quality of healthcare needs to be addressed to improve health outcomes.

Mothers at an RCH Clinic waiting for services. They wait not knowing whether vaccines will be available. Where and to whom do they communicate these challenges?

Problem

The problem is two-fold: Community members visiting health facilities are unaware of the proper channels to offer feedback about the quality of health services that they receive, and health facility authorities are unaware of the issues faced by the community when accessing health services. A needs assessment at Misungwi, Misasi, Koromije and Bukumbi health centers uncovered specific concerns at each location, some of which had never been heard by the hospital administrator. Indeed 50% of the patients interviewed said that they shared their concerns about the hospital only with village leaders or amongst themselves, and only 5% of those interviewed were aware of a mobile phone-based feedback system implemented by the Ministry of Health called Afya Maoni.

The lack of platform to facilitate communication between patients and medical staff prevents quality improvement in health service delivery. Moreover, without a platform to share community feedback, the Ministry of Health lacks data about the quality of health services delivered by facilities and cannot leverage feedback to inform resource mobilization and timely intervention.

Solution

The solution proposed to bridge this communications gap is a Community Feedback System (CFS) called “Our Voice, Our Health” that will allow patients to express concerns about the quality of health services that they receive. Health facility authorities will be able to access this community feedback directly. The actions taken by health facility authorities to address community concerns will also be shared back with the community, completing a feedback loop that keeps all stakeholders informed.

Everyone – from the Ministry of Health to the local community – will be able to access the data in the platform through a website to check service quality, understand the specific issues that have been flagged, and find out how facility staff have tackled shortcomings at a particular facility.

Process

The team is taking a proactive approach to ensuring that the voices of patients are heard: A feedback survey will be sent by SMS directly to registered community members, whose information will have been obtained – and consent given – at the hospital. A multiple-choice survey will guide patients through the feedback process, and the option to provide open-ended responses will also be available. This feedback will be integrated into a database that will be shared with health facility administrators, who will be invited to respond. Their responses will be incorporated into the database and disseminated to CFS users. The project will be piloted in Misungwi District with four health facilities.

Lack of community awareness forestalled the implementation of a similar project planned by the Ministry of Health. Building on this lesson learned, CFS plans to raise awareness and build community buy-in through mass media campaigns, training, and the involvement of community health workers and village leaders.

Expected Impacts

The CFS team is endeavoring to give the people of Tanzania a voice to share their views on the quality of health services they receive and to provide this data to service providers and health governing bodies to improve the quality of healthcare in Tanzania.

• Community members will have a medium to share their concerns on the quality of health service delivery and to receive feedback on actions taken by the health facility authorities to address these concerns. This feedback loop will increase their trust in the health system and foster collaboration to improve health service quality.
• Health service providers will be aware of the community’s perception of their services and areas for improvement. This information will facilitate better allocation of funds and planning prioritization.
• The Ministry of Health (MoH) will be able to use data on limitations to high quality healthcare access in specific communities to rate health facilities and mobilize resources for quality improvement.
• The community feedback data can be made available to donors or other stakeholders interested in improving healthcare services in Tanzania, and this data can inform their priority areas of focus and related funding decisions.

Key Collaborators

Dr. Rachel Nungu and her team of three received a $17,000 grant from the Data for Local Impact Innovation Challenge (DLIIC) in March 2017. The grant will enable Rachel and her team to develop the CFS database and pilot the project in Misungwi District for a period of three months.

The Data for Local Impact Innovation Challenge (DLIIC) is providing financial and technical support to this project. DLIIC is fostering data-driven innovations through small grant challenges for youth and entrepreneurs. Visit www.dlinnovationchallenge.com or follow DLIIC on Twitter @DLIinnovation for more information.