Peer-reviewed article
Partial pictures: what routine health data can and cannot tell us about the quality of maternal and neonatal health services in Tanzania.
Molenaar J, Kikula A, Julius Z, Hanson C, van Olmen J et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how well Tanzania's routine health information systems capture the quality of maternal and newborn health services. Researchers interviewed healthcare workers, managers and policymakers at facility, district, regional and national levels in Mtwara region and nationally. The findings show that while routine data provides valuable information about service coverage, it captures only limited information about the quality of care processes and patient experience, and current top-down data systems do not support local health service improvement.
Key points
- Tanzania's routine health information systems provide a partial picture of maternal and neonatal care quality, missing care processes and patient experience
- Contact coverage metrics can overestimate the benefits of care because they do not measure quality of services provided
- Current top-down emphasis on data collection for oversight acts as a barrier to local-level data use for improvement
- Standardized routine health information systems cannot comprehensively capture the multifaceted nature of care quality
- Quality measurement requires a shift from extracting data for higher levels to creating platforms that generate value for healthcare providers
Limitations
This qualitative study explores stakeholders' perspectives on data systems rather than directly measuring maternal and neonatal health outcomes or the actual quality of care delivered. The findings are based on research in one region (Mtwara) and may not represent all of Tanzania or other countries.
Abstract
Measurement of contact coverage of maternal and newborn health services may overestimate the benefits of the care that is provided, because the quality of care is not captured. It is therefore important to better understand the opportunities and challenges of capturing elements of care quality in routine health information systems (RHIS). This study explored healthcare workers' (HCWs), health sector managers' and policymakers' perspectives on the value and limits of routine health data to understand the quality of maternal and neonatal health services in Tanzania. We conducted qualitative research during two periods to capture perspectives across facility, district, regional and national levels. In Mtwara region in 2023, we conducted ethnographic observations at two hospital labour wards and 29 in-depth interviews with healthcare workers, hospital leaders, and district/regional managers. In 2025, we carried out 17 additional interviews with regional managers in Mtwara and with key national-level stakeholders. Our findings demonstrate that Tanzania's RHIS provides a valuable but partial picture of quality of care for maternal and neonatal health services. Care processes-including both provision and experience of care-are captured only to a limited extent. Using boundary object theory, we highlight how the same health information must serve diverse stakeholder needs. While there are opportunities to integrate more quality-of-care indicators, standardized RHIS cannot be expected to comprehensively capture the multifaceted nature of care quality. For quality measurement to support meaningful local health service improvement, a flexible, bottom-up approach is essential. However, the current emphasis on top-down oversight acts as a barrier for local-level data use. Relevant and feasible measurement of the quality of facility-based care requires a fundamental shift in current RHIS priorities-from systems that extract data for those 'up there' to platforms that also create value for those who provide care.