AfyaPamoja was founded in 2021 by the four co-founders motivated by elevating citizen voices in the delivery of public services in Tanzania, putting citizens’ voices at the centre of government decision-making.

Within primary healthcare facilities in Tanzania, patients need more channels to provide feedback on the services and care they receive. The typical facility receives just two pieces of patient feedback per month, typically via paper and pen notes put into suggestion boxes. 60% of patients say that existing feedback mechanisms are inadequate. As a result, patient voices are not sufficiently heard in healthcare decision-making. This is particularly true for pregnant women who often experience abuse from healthcare workers during visits to facilities but are unable to share this feedback with service providers and the government (who provided reproductive and child health services for 85% of women in Tanzania).

The grant applied by Afya Pamoja to implement this project intends to use a digital patient feedback platform (in the form of SMS surveys sent via the patient’s mobile phone) to allow pregnant women to provide feedback on the quality of care they receive. In particular, they can report instances of abuse and inadequate care. By providing this feedback channel, evidence shows that this builds trust in services, leading to increased service utilisation. Evidence from similar services suggests that this can increase utilisation by 20% (e.g. antenatal care visits). This results in improved healthcare impacts such as maternal, infant and under-5 mortality. Two seminal pieces of work found that social accountability mechanisms can reduce under-5 mortality by up to 38%. Insufficient patient feedback also reduces the ability of healthcare workers and public healthcare managers’ ability to understand patients’ real-time needs and challenges on a local level. This limits their ability to provide targeted oversight and support to healthcare workers or patients (e.g. identifying abusive healthcare workers or training requirements for quality improvement). It also reduces their ability to understand local resource needs (e.g. determining where antenatal folic acid supplements are out of stock).

For pregnant women, access to adequate healthcare services at this time is essential for their future productivity. Without effective care for them and their child during pregnancy, their ability to pursue productive employment opportunities post-birth is significantly reduced. This may be because they or their child suffer complications during pregnancy or labour. Providing high-quality, responsive healthcare services is the best way to support vulnerable pregnant women post-pregnancy. This project will involve implementing this service in 125 Dar es Salaam region facilities.