Designing and Implementing Health System Strengthening Intervention Using Performance Score Card; the Effect on Health Service Delivery in Tanzania, a Study Protocol

<i>Introduction</i>: Sustainable development goals (SDGs) need to be achieved by Low and Middle Income countries in order to achieve the Universal Health Care (UHC). The strategies and interventions to achieve UHC need to be robust and effective for health system to work optimally. Simiyu Region (Health department) designed a health system strengthening (HSS) intervention which uses a continuous quality improvement (CQI) approach to address health system challenges. The designed HSS intervention had a major focus on improving health system performance using governance and leadership health system pillar as a lever. <i>Methods</i>: This is a prospective observational study implemented along with national essential health intervention packages. The governance priority areas included formulation of performance measurement/score card tool with 34 indicators and 87 operational standards comprised of structural, processes and outcome indicators. Governance domains are; supportive supervision, data quality assessment, monthly and quarterly data review meetings, star rating assessment, health facility governance committee meetings, medicine and drug audit and so forth. Performance measurement was done in all six councils quarterly to ensure intervention institutionalization and improved indicators performance. <i>Data collection: Quantitative data;</i> Data collection tools for the intervention will be developed according to the objectives, research questions and outcomes and outputs from this intervention. Routine data collection tools of Ministry of Health will be used to collect data outcome data of service delivery. Observational data of governance performance are collected using the generated performance measurement tool. <i>Qualitative data.</i> Will be collected using in-depth interviews and focus group discussions with regional and council management teams, health care staff, HMTs and council leaders. The interview will explore program acceptability, drivers and barriers towards its implementation of this intervention. <i>Data analysis: Quantitative</i> data will be analyzed using appropriate statistical software and data are presented in tables, charts and frequencies. Statistical significance test for association of independent and dependent variables will be performed accordingly. Qualitative data will be analysed by using Ground theory where the contents analysis will be performed after the data being transcribed verbatim. <i>Discussion: </i>Leadership and governance is critical cross-cutting pillar for HSS. Routine performance measurement using validated tool is important to monitor the strengths and weaknesses of governance structures and health system performance with end results of health system responsiveness and resilient. <i>Conclusion: </i>HSS interventions with CQI involving leadership and governance are indispensable in restricted resource countries for achieving large ends with restricted resources.