Changing health care provider performance through measurement.

Can the quality of care be improved by repeated measurement? We show that measuring protocol adherence repeatedly over ten weeks leads to significant improvements in quality immediately and up to 18 months later without any additional training, equipment, supplies or material incentives. 96 clinicians took part in a study which included information, encouragement, scrutiny and repeated contact with the research team measuring quality. We examine protocol adherence over the course of the study and for 45 of the original clinicians 18 months after the conclusion of the project.

Perceptions of AIDS risk and condom use among out-of-school adolescents in Moshi rural district, northern Tanzania.

Objective: To determine the magnitude of perceived AIDS risk among out-of-school adolescents in Moshi rural district of Kilimanjaro region, northern Tanzania.

Methods: A cross-sectional study involving face-to-face interviews with out-of-school adolescents in eleven rural villages in Moshi district, northern Tanzania.

Results: We found that of the 668 adolescents (10-19 years of age) surveyed, 45.

Prevalence of and predictors of substance use among adolescents in rural villages of Moshi district, Tanzania.

Purpose: To determine the prevalence of substance use among primary school pupils and out-of-school adolescents in Moshi rural district, northern Tanzania.

Methods: A school-based cross-sectional study focusing on primary school adolescents in standards 6 and 7 in Kahe rural community. We also conducted a population-based cross-sectional study among out-of-school adolescents in the same rural villages.

Professionalism and the know-do gap: exploring intrinsic motivation among health workers in Tanzania.

Professionalism can be defined generally as adhering to the accepted standards of a profession and placing the interests of the public above the individual professional's immediate interests. In the field of medicine, professionalism should lead at least some practitioners in developing countries to effectively care for their patients despite the absence of extrinsic incentives to do so. In this study we examine the behavior of 80 practitioners from the Arusha region of Tanzania for evidence of professionalism.

Sexual practices among unmarried adolescents in Tanzania.

Background: Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania.

Status and visions for the school health service as reported by local health care workers in Northern Tanzania.

Objective: The World Health Organization's (WHO) Global School Health Initiative provides a strategy to utilize schools to promote health and reduce the burden of diseases worldwide. The aim of this study was to investigate local school health work in Tanzania in relation to existing national guidelines and the WHO initiative.

Methods: We interviewed 30 health care workers employed at 15 health institutions throughout Arusha and Kilimanjaro regions.

Predictors of risky sexual behavior among adolescents in Tanzania.

Studies on sexual behavior among adolescents are fundamental in understanding and fighting against outcomes of unprotected sex that include unplanned/unwanted pregnancies and sexually transmitted diseases. This survey conducted among in- and out-of-schools adolescents measured prevalence of sexual behavior variables, including risky sexual behavior and associated factors. Risky sexual behavior was defined as having first sex before 16 years, inconsistent condom use and having multiple sexual partners.

Variations in the quality of care accessible to rural communities in Tanzania.

The government of Tanzania has made access to health care a priority. In particular, it has made great efforts to increase the number of facilities available to the rural population. By examining one such rural area, we find that although facilities exist and are staffed with competent clinicians, the quality of care received by patients visiting government facilities is subpar, especially that received by the poor in rural areas compared with urban areas.

Outpatient process quality evaluation and the Hawthorne Effect.

We examine the evidence that the behavior of clinicians is impacted by the fact that they are being observed by a research team. Data on the quality of care provided by clinicians in Arusha region of Tanzania show a marked fall in quality over time as new patients are consulted. By conducting detailed interviews with patients who consulted both before and after our research team arrived we are able to show strong evidence of the Hawthorne effect.

The use of direct clinician observation and vignettes for health services quality evaluation in developing countries.

This paper reports the results of a comparison between two different methods of examining quality in outpatient services in a developing country. Data from rural and urban Tanzania are used to compare the measures of quality collected by direct clinician observation (DCO) (where clinicians are observed in the course of their normal consultations) and vignettes (unblind case studies with an actor). The vignettes are shown to exhibit a strong connection between the inputs provided during consultation (rational history taking, physical examination and health education) and the ability of the clinician to properly diagnose the presented illness.

Frequency and perceived credibility of reported sources of reproductive health information among primary school adolescents in Arusha, Tanzania.

Aims: To describe adolescents' sources of reproductive health information and perceived credibility of these sources.

Methods: A questionnaire survey was conducted among 1247 seventh grade pupils in Arusha district; enquiring their sources of reproductive health information and perceived credibility of these sources. Mean scores were computed for each type of information in relation to frequency of source and credibility, and scales for reproductive health information sources and credibility constructed.