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

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.

Key messages
- Routine health data have the potential to offer fine-grained insight into the quality of care provided to women and newborns.
- Rigid standardization of quality-of-care measurement is untenable and will fail to accommodate local quality improvement needs in settings like Tanzania, requiring more flexible and adaptable approaches designed from the bottom-up.
- RHIS work best when they create value for those who generate the data, not just those who consume it for oversight purposes, requiring a reorientation to prioritize care over control across health system levels.
- Individual electronic health records combined with patient feedback mechanisms hold promise for improving Tanzania's RHIS, but transforming the system requires fundamental shifts in who defines measurement priorities and whose knowledge counts in system design.