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 skil ls, but most assessments undertaken in developing countries focus only on technical skills. This study from Tanzania used explicit observati on checklists to review the process of providing antenatal, curative a nd 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 heal th units appear to be influenced by factors such as workloads, structu re and staff allocations. Differences between cadres were also identif ied and may underlie some of the inter-unit differences. The policy ac tions required to address the problems must reflect the diversity of t he underlying influences, seeking to raise both technical and inter-pe rsonal quality, as the two are mutually reinforcing.