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New paper with @eliakimueliudi @SanamRoderDeWan @mkruk @TalhiyaYahya et al examines the importance of context in a facility quality improvement project in Tanzania in the @WHOBulletin https://www.who.int/bulletin/volumes/98/12/20-258145.pdf
We find that while most facilities improved after 3 years, there was a lot of heterogeneity across facilities
What was responsible for the heterogeneity? Not only facility characteristics like participation in RBF, but also the population density surrounding the facility and whether nearby facilities also improved.
Most of the improvement was also in facilities that had the lowest scores at baseline, suggesting that the Star Rating Assessment could be effective in bringing up the floor, but not necessarily raising the ceiling on quality of care.
As national data and feedback strategies become more common (like South Africa's Ideal Clinics), it's important to look at the contexts in which facilities are able to improve quality and support those that are working in challenging environments.
