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Addressing quality in the private healthcare sector – a randomised controlled trial of the SafeCare Quality Improvement Programme in Tanzania

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SafeCare is a quality improvement model developed by the NGO PharmAccess, aimed at lower-level public and private health facilities in sub-Saharan Africa. The private sector is a major and growing source of care, but there are concerns about quality and safety, and these are insufficiently addressed by government regulation or international hospital accreditation standards. SafeCare was designed to address this gap, offering realistic setting-appropriate standards and stepwise certification, as well as access to credit for implementing improvements.

We undertook a large-scale randomised controlled trial to evaluate the impact on quality of care of the roll out of SafeCare to private for-profit and faith-based facilities in Tanzania. The trial assessed the effects on the quality of care received by patients through comparison of 237 intervention and control facilities after 1.5–2 years of implementation. To do this, we:

  • measured clinical quality through standardised patient surveys
  • observed infection prevention and control (IPC) behaviours
  • conducted in-depth interviews with facility in-charges and implementing staff to assess the perceived benefits and costs of participating, and the factors affecting quality improvement and business performance.
  • interviewed national level key informants to explore how the SafeCare model had shaped the market for healthcare and the policy environment

The results are expected to make an important contribution to the evidence base on improving private sector care, and to the literature on measuring process quality of patient care. 

Publications

Other outputs 

People 

Ifakara Health Institute: Christina Makungu, Abdallah Mkopi

PharmAccess Foundation: Nicole Spieker, Peter Risha

Dates

Until end of June 2020