Partial pictures: what routine health data can and cannot tell us about the quality of maternal and neonatal health services in Tanzania

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative research

• Effect Size: Not applicable for qualitative research

• Primary Outcome: Tanzania's RHIS provides valuable but partial picture of quality of care for maternal and neonatal health services

• Nnt Or Sensitivity: Care processes captured only to limited extent in current RHIS

• Confidence Interval: Not applicable for qualitative research

Clinical Application

Findings suggest need for fundamental shift from top-down data extraction to bottom-up platforms that create value for care providers Limited direct applicability to Australian context given focus on low-resource health system challenges, though principles of quality measurement and health information system design may be relevant for Aboriginal and Torres Strait Islander health services Health system managers, policymakers, and healthcare workers involved in maternal and neonatal health services in low-resource settings

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.

References

1. 1.Molenaar, J., Kikula, A., Julius, Z., Hanson, C., van Olmen, J., Pembe, A. B., & Beňová, L. (2026). Partial pictures: what routine health data can and cannot tell us about the quality of maternal and neonatal health services in Tanzania. Health Policy and Planning. https://doi.org/10.1093/heapol/czag030