{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:36:16Z","timestamp":1789011376525,"version":"build-2803163510"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Flanders research foundation","doi-asserted-by":"publisher","award":["1130325N"],"award-info":[{"award-number":["1130325N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007601","name":"European Commission\u2019s Horizon 2020","doi-asserted-by":"publisher","award":["847824"],"award-info":[{"award-number":["847824"]}],"id":[{"id":"10.13039\/501100007601","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2019 (HCWs), health sector managers\u2019 and policymakers\u2019 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\u2019s RHIS provides a valuable but partial picture of quality of care for maternal and neonatal health services. Care processes\u2014including both provision and experience of care\u2014are 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\u2014from systems that extract data for those \u2018up there\u2019 to platforms that also create value for those who provide care.<\/jats:p>","DOI":"10.1093\/heapol\/czag030","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T12:49:35Z","timestamp":1772628575000},"page":"747-760","source":"Crossref","is-referenced-by-count":2,"title":["Partial pictures: what routine health data can and cannot tell us about the quality of maternal and neonatal health services in Tanzania"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4154-6478","authenticated-orcid":false,"given":"Jil","family":"Molenaar","sequence":"first","affiliation":[{"name":"Family Medicine and Population Health, University of Antwerp , Doornstraat 331, Wilrijk 2610 ,","place":["Belgium"]},{"name":"Department of Public Health, Institute of Tropical Medicine Antwerp , Sint-Rochusstraat 43, Antwerp 2000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1130-9279","authenticated-orcid":false,"given":"Amani","family":"Kikula","sequence":"additional","affiliation":[{"name":"Family Medicine and Population Health, University of Antwerp , Doornstraat 331, Wilrijk 2610 ,","place":["Belgium"]},{"name":"Department of Public Health, Institute of Tropical Medicine Antwerp , Sint-Rochusstraat 43, Antwerp 2000 ,","place":["Belgium"]},{"name":"Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences , United Nations Road, P.O. Box 65001, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zamoyoni","family":"Julius","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Aga Khan University , Urambo Street 344, P.O. Box 38129, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8066-7873","authenticated-orcid":false,"given":"Claudia","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet , Tomtebodav\u00e4gen 18A, Solna 171 65 ,","place":["Sweden"]},{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9724-1887","authenticated-orcid":false,"given":"Josefien","family":"van Olmen","sequence":"additional","affiliation":[{"name":"Family Medicine and Population Health, University of Antwerp , Doornstraat 331, Wilrijk 2610 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8090-3298","authenticated-orcid":false,"given":"Andrea Barnabas","family":"Pembe","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences , United Nations Road, P.O. Box 65001, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8595-365X","authenticated-orcid":false,"given":"Lenka","family":"Be\u0148ov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine Antwerp , Sint-Rochusstraat 43, Antwerp 2000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"2026052004164845600_czag030-B1","first-page":"578","article-title":"Health information systems: the foundations of public health","volume":"83","author":"AbouZahr","year":"2005","journal-title":"Bull World Health Organ"},{"key":"2026052004164845600_czag030-B2","doi-asserted-by":"publisher","first-page":"e073412","DOI":"10.1136\/bmj-2022-073412","article-title":"Regular measurement is essential but insufficient to improve quality of healthcare","volume":"380","author":"Agweyu","year":"2023","journal-title":"BMJ"},{"key":"2026052004164845600_czag030-B3","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1080\/14780887.2020.1769238","article-title":"One size fits all? 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