"If really we are committed things can change starting from us providers" Improving postpartum care : A facilitation intervention at government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania

Abstract: Globally, postpartum care is a neglected area in the continuum of maternal and newborn services. Facilitation interventions focusing on addressing local problems report positive results in improving the health of mothers and newborns in low-resource settings. The aim of this thesis was to investigate a facilitation intervention to improve postpartum care at government-owned health institutions in a low-resource suburb of Dar es Salaam, Tanzania. A before-and-after study design was used to describe and evaluate the intervention in this thesis. Data were collected using mixed methods in the intervention group and the control group, before and after the intervention and were used for making comparisons.  The baseline studies showed that postpartum care practices were next to non-existent at the institutions, that most healthcare providers had high levels of knowledge, positive attitudes towards postpartum care and declared themselves ready to engage in its improvement. Mothers coming with their newborns for immunisation were satisfied with the services. The intervention to improve postpartum care involved healthcare providers in six geographical clusters, each including 3–6 institutions, with one facilitator for each cluster. Using a participatory approach, they facilitated colleagues in identifying and addressing the provision of postpartum care at institutions. Data were collected among healthcare providers, facilitators and mothers using: focus group discussions; questionnaires; observations; and interviews, and by making field notes, written at each institution. In the intervention, facilitators and healthcare providers used four strategies to improve postpartum care:increasing awareness and knowledge on postpartum care of healthcare providers and mothers; mobilising professional and material resources; improving care routines, communication and documentation; and promoting an empowering and collaborative work style. The endline evaluation showed that postpartum care was conducted in the intervention group with some care items performed for 80% of observed mothers. The quality grading, which involved nine experts and was based on national guidelines, showed that none of the healthcare providers reached the level of good quality of care. In the comparison group, postpartum care continued to be next to non-existent. The healthcare providers’ knowledge increased in both groups but to a higher extent in the intervention group. The t-test indicated a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference in differences for knowledge was 1.3. The attitudes showed no major difference between baseline and endline in the intervention and comparison groups. This facilitation intervention was an acceptable and applicable approach and indicates promising results in improving the quality of postpartum care and in increasing mothers’ attendance.