Assessment of process quality in Tanzanian primary care.

Process quality is the commonly used operational definition of health care quality. Its key components are technical and inter-personal skills, but most assessments undertaken in developing countries focus only on technical skills. This study from Tanzania used explicit observation checklists to review the process of providing antenatal, curative and nursing care in primary health units, assessing both technical and inter-personal skills. The study findings emphasize the weaknesses in available care, particularly in the attitudes of health staff but also in aspects of technical care. Differences in performance between health units appear to be influenced by factors such as workloads, structure and staff allocations. Differences between cadres were also identified and may underlie some of the inter-unit differences. The policy actions required to address the problems must reflect the diversity of the underlying influences, seeking to raise both technical and inter-personal quality, as the two are mutually reinforcing.