A trial of a quality improvement programme in the private sector in Tanzania

Private facilities are a major and growing source of treatment in low- and middle-income countries (LMIC), but there is considerable concern about the safety and quality of care. This research takes place in the context of an innovative quality improvement intervention developed by the international NGO PharmAccess to improve private sector quality, termed SafeCare.

SafeCare extends the benefits of clinical standards and stepwise certification to small and medium-sized facilities in LMIC, using standards developed with international accreditation bodies. We are conducting a randomised controlled trial of SafeCare.

Measurement of the impact on clinical quality of care includes:

(i) standardised patients, presenting with suspected malaria, suspected asthma, suspected TB or an upper respiratory tract infection;
(ii) observation of infection, prevention and control (IPC) behaviours among facility staff.

Both these study components have relevance for AMR: the standardised patients highlight the high levels of (often unwarranted) antibiotic provision, while the IPC observations highlight inadequacies in infection control, for example in the area of hand hygiene.

Project Duration: 2016 – 2019
LSHTM lead investigator: Catherine Goodman
LSHTM staff: Tim Powell-Jackson, Catherine Goodman, Jessica King
Funding: The Health Systems Research Initiative (MRC/DFID/ESRC/WT)
Collaborators: Ifakara Health Institute, PharmAccess International
Location: Tanzania