January 2018

EGPAF Empowers Beneficiaries to Influence Quality of Health Services

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Adult HIV Care and Treatment; Community Mobilization; Health Systems Strengthening

Hadija Kanuti has been a client at the health facility in Karatu, Tanzania since it was just a two-room dispensary. Having lived in the small town for the past 45 years, she has seen the facility evolve into its current state with more complex amenities. The facility serves three wards comprising of 11 villages and more than 62,000 people.

Hadija and thousands of other residents in the Karatu District endured a number of challenges in receiving high quality of service at the hospital. Some of the more glaring challenges included: congestion at the reception/registration window and negative attitudes from some of the service providers.

The environment was also not soothing for patients. A police station across the street was often flooded with activity and noise – causing unrest and unease among the people seeking care at the health facility. The facility lacked an ambulance making it difficult to transport people in need of emergency services. Continuous and reliable power was also an issue – the facility’s operating theater had no standby generator in case of an outage of grid electricity at critical times.

Solutions to these challenges were catalyzed by a “consumer voice” initiative implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) with funding from the United States Agency for International Development (USAID).

EGPAF formulated the consumer service model and facilitated training for 12 community representatives chosen by community leaders and endorsed by community members. These representatives are known as “Facilitators of Consumer Voice”. Initially, community members point out problems through representatives in the consumer voice meetings convened by facilitators of consumer voice.

“In these meetings we discuss good things and bad things about the health facility from the perspective of people who use its services,” says Tina Pius, the group’s secretary.

Two members of the Consumer Voice group also sit on the Karatu Health Facility’s quality improvement (QI) committee. The QI committee has a member from each t department of the facility. This particular health facility has an outpatient department, in patient department, laboratory, operating theatre, HIV care and treatment department and reproductive and child health department. Solutions to identified problems are determined collaboratively between the consumer voice groups and the health facility’s quality improvement committee.  After two meetings with community members, the group presented five areas in need of improvement to the QI committee. The areas were:

  • Congestion at the outpatient department (OPD) registration
  • Negative attitude from many health care workers
  • Lack of an ambulance
  • Lack of a standby generator for the operating theatre
  • Noisy ammunition explosions from the nearby police station

Since then, each area has dramatically improved upon, thanks to the collaborative approach and joint monitoring of progress by   the Consumer Voice group and Karatu Health Facility’s quality improvement (QI) committee.

“We even got an opportunity to go through every room of the hospital and take notes about improvement, says Tina.

“I think the Consumer Voice system works very well, because it gives us an opportunity to review the quality of service from the point-of-view of the patient or client and not just the service provider,” says Hadija. says Hadija.

“It enables people, who in most circumstances, would not have influence on a decision or access the decision maker,” says Tina Pius.

Working Towards Solutions

Hadija witnesses that attitude of health workers has also changed for better. “Many of our health care workers, nowadays, are welcoming and [use kinder and more understanding language] when dealing with patients.”

“I have seen a lot of improvement in the attitude of nurses towards patients. We got feedback from the committee that some of us used harsh language to clients. I see service providers have taken the feedback seriously,” says Taus Melkizedeki Komba, a nurse assistant at Karatu Health Center. She has worked at this facility in Out Patient Department (OPD), Labour ward, Reproductive and Child Health (RCH) and now she is working at Care, Treatment and Counselling (CTC).

Introducing a numbering system of patients as they entered the facility solved the issue of long wait times. A patient now waits for his/her number to be called out and then proceeds to register at the allotted window. After that they are able to see a doctor. The reception area has also been zoned, so that clients who subscribe to health insurance have their own window apart from those paying cash.


“Now the facility has a generator and they have started performing minor surgeries,” says Hadija.

Consumer Voice representative are still working to secure an ambulance for the facility and are hopeful that with strong collaboration with facility staff, they will find a solution soon.