Barriers to conducting effective obstetric audit in Ifakara: A qualitative assessment in an under-resourced setting in Tanzania

Department of Obstetrics and Gynaecology, Saint Francis Designated District Hospital, Ifakara, Tanzania  Department of Medical Humanities, EMGO+ Institute, VU University Medical Centre, Amsterdam, The Netherlands  Tanzanian Training Centre for International Health, Ifakara, Tanzania  Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands  Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, Tanzania.
Tropical Medicine & International Health (Impact Factor: 2.33). 04/2012; 17(5):652-657. DOI: 10.1111/j.1365-3156.2012.02972.x
Source: PubMed


Objective  To explore barriers to and solutions for effective implementation of obstetric audit at Saint Francis Designated District Hospital in Ifakara, Tanzania, where audit results have been disappointing 2 years after its introduction. Methods  Qualitative study involving participative observation of audit sessions, followed by 23 in-depth interviews with health workers and managers. Knowledge and perceptions of audit were assessed and suggestions for improvement of the audit process explored. Results  During the observational period, audit sessions were held irregularly and only when the head of department of obstetrics and gynaecology was available. Cases with evident substandard care factors were audited. In-depth interviews revealed inadequate knowledge of the purpose of audit, despite the fact that participants regarded obstetric audit as a potentially useful tool. Insufficient staff commitment, managerial support and human and material resources were mentioned as reasons for weak involvement of health workers and poor implementation of recommendations resulting from audit. Suggestions for improvement included enhancing feedback to all staff and managers to attend sessions and assist with the effectuation of audit recommendations. Conclusion  Obstetric staff in Ifakara see audit as an important tool for quality improvement. They recognise, however, that in their own situation, insufficient staff commitment and poor managerial support are barriers to successful implementation. They suggested training in concept and principles of audit as well as strengthening feedback of audit outcomes, to achieve structural health care improvements through audit.

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Available from: Marianne van Elteren
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    • "The issue of recommendations lies in the question of whether the recommendations will be acted upon and subsequently evaluated. Previous studies have shown that recommendations resulting from the audit sessions were poorly implemented because of a lack of human and material resources and insufficient staff and senior management commitment [13,14]. Conversely, in other studies where recommendations were implemented and evaluated, reductions in maternal mortality, the case fatality rate [50,51], the incidence of uterine rupture, obstetric hemorrhage and the number of women with severe maternal complications were observed [52,53]. "
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