Quality of maternal and child health services in Tanzanian primary healthcare: a 2021-2022 star rating review.
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BACKGROUND: Tanzania faces high maternal and infant mortality rates, yet key service quality metrics remain underexamined, limiting targeted improvements. Star Rating Assessment (SRA), introduced in 2015, aims to improve primary health care (PHC) quality, including maternal and child health (MCH) services. This study analyses SRA data to assess the prevalence of PHC quality in MCH and its associated factors. METHODS: Data for this cross-sectional study were collected from November 2021 to March 2022 across 10 regions. The tool used included 12 MCH-related indicators, each comprising specific criteria. Facilities scoring ≥ 80% across these criteria were considered to meet MCH quality standards, which was the primary study outcome. A descriptive analysis of indicator performance was conducted, followed by multivariate logistic regression to assess characteristics associated with achieving the quality standard. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: A total of 2,583 facilities assessed: 2,189 dispensaries (84.7%), 303 health centres (11.7%), and 91 district-level hospitals (3.5%). Only 280(10.8%) met the MCH quality standards. Maternal audit and review practices aligned with guidelines in 2,057 facilities (79.6%). Moderate adherence was observed for family planning guidelines (48.3%), accurate partogram completion (47.9%), and immunisation standards (46.3%). Major gaps included cervical cancer screening, offered by 199 facilities (7.7%), and essential obstetric medicines, available in 424 facilities (16.4%). Among 394 hospitals and health centres, only 60(15.2%) offered postnatal and essential newborn care with dedicated neonatal and Kangaroo Mother Care spaces. Compliance was higher in public, rural, and higher-level facilities. Nurse availability, functional management, and quality improvement teams were key predictors of MCH quality. CONCLUSION: The quality of MCH services in Tanzania varies widely by facility type, ownership, nurse staffing, and management functionality. Targeted improvements in cervical cancer screening, emergency obstetric care, and newborn care are essential to raise overall MCH service standards.