RESEARCH PROBLEM AND JUSTIFICATION
Recognizing that efforts to save lives must be accelerated, in 2015 the government launched the National Roadmap Strategic Plan to Improve Reproductive, Maternal, Newborn Child and Adolescent Health in Tanzania 2016-2020 (Sharpened One Plan II). The One Plan II has set targets in areas related to Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services to: 1) increase the number of health centres providing CEmONC services from the current 12% to 50%; and 2) increase the number of dispensaries providing basic EmONC (BEmONC) services from the current 13% to 70%. As of 2015, less than 20% of the health facilities that conduct delivery provide BEmONC (Tanzania Ministry of Health and Social Welfare, 2015). This study aims to assess the impact of strengthening skills in leadership and managerial capacities of professionals who deliver babies in the five intervention health centres of the ASDIT project and their referring dispensaries.
Health care professionals need to enhance their leadership and managerial capacities to be at the forefront of the transformational process which requires a stronger integrated health care approach, in the design, delivery, monitoring and evaluation of the system.
Theoretical framework for needs-based health systems strengthening
Figure 1: Conceptual framework for needs-based health systems and HRH planning
RESEARCH AIMS, QUESTIONS AND OBJECTIVES
This proposal aims to enhance the objectives of the IMCHA project Accessing Safe Deliveries in Tanzania (ASDIT) by addressing the identified gaps in leadership and managerial capacities and BEmONC skills. Both factors contribute to achieving a sustained intervention to improve provision of quality emergency obstetric and newborn care in health facilities (centres and dispensaries).
The research questions are:
- Does leadership and managerial capacities building for health care providers, managers and other key stakeholders lead to improved health care practice within health facilities?
- Does strengthening of BEmONC skills among health care providers in health facilities lead to improved pregnancy and newborn outcomes?
To improve health care practice and quality of MNCH healthcare delivery at health centres and dispensaries through capacity-building in leadership, management, governance and accountability and through increasing the capacity to provide BEmONC services.
- To assess the leadership and managerial knowledge and skills gaps among HMT, CHMTs and HFMTs, on implementation of CEmONC services delivery in health facilities.
- To bridge the MNCH leadership and management knowledge and skills gaps among the key actors.
- To assess and compare the effects of MNCH leadership and managerial capacity building of the RHMT, CHMTs and HFMTs, on implementation of CEmONC services delivery in health centres offering CEmONC.
- To assess the skills gaps in BEmONC among the care providers in health facilities within the catchment areas.
- To determine the impact of strengthening BEmONC services in health facilities.
The proposed study will employ a mixed method, participatory approach (PA) (Minkler & Wallerstein, 2008) to research and capacity building using a quasi-experimental prospective cohort design with the same five intervention health centres as in the ASDIT project while adding their referring dispensaries and their catchment areas. For comparison, five control health centres and their referring dispensaries plus catchment areas will undergo the same measurement of leadership capacity and health facility functioning but will not be offered an intervention.
Leadership and Managerial capacity building training programs participants: Leadership capacity building training programs will involve key actors from the regional level down to the community i.e., including the Morogoro RHMT, the CHMTs (from all 9 councils), and Health Facility Management Teams (HFMTs) of the five ASDIT supported health centres and the same number of control facilities. The participants will be of both genders to provide gender equity in leadership training opportunities throughout the project
Results and Dissemination
The results will be disseminated in collaboration with the established HPRO for the ASDIT project. The expertise of the HPRO will be essential in supporting the uptake of research into policy- and decision-making at the country level through existing and developing networks, and also in facilitating shared learning with other Implementation Research Teams. Dissemination of the findings of the project will occur through the KT strategies within Tanzania, across established networks and international conferences. Manuscripts will be submitted to open-access journals such as the BMC Health Services Research or Human Resources for Health.