In Tanzania, improving the quality of healthcare is not only a matter of funding or infrastructure—but is largely driven by the motivation, teamwork, and leadership within health facilities, a recent study has found.

The research, published in PLOS Global Public Health, examined how more than 5,500 primary health facilities responded to Tanzania’s Star Rating Assessment (SRA) programme, introduced in 2015 to measure and improve the quality of care.

While some facilities showed strong progress, others made little progress despite operating in similar conditions, the study found. Researchers say the variation cannot be explained by resources alone, but also by how healthcare workers understand and engage with their work.

“The SRA helped primary care providers and staff in Tanzania find meaning in their work by linking that work to a national mission to improve quality of care,” the authors wrote.

Why it matters

The study comes at a time when many countries are seeking cost-effective ways to improve healthcare quality. It shows that meaningful change can be achieved not only through increased funding, but also on building a culture of accountability, teamwork and purpose among health workers.

Ifakara scientists contribute to the study

The study was conducted in collaboration with researchers from the Ifakara Health Institute, including Donat Shamba, Heller Rajab, Magret Somba, and Mary Ramesh, alongside partners from the United States and the Tanzania Ministry of Health.

Meaning-making at the heart of improvement

The study highlights what researchers describe as “meaning-making” among healthcare workers as a key driver of improvement.

Facilities that performed better were those where workers reported a strong sense of purpose and ownership over their work.

According to the findings, workers were more likely to deliver better care when they felt part of a shared mission to improve service quality.

The power of leadership and teamwork

The research also found that strong internal relationships played an important role in performance.

High-performing facilities were more likely to have supportive leadership, effective teamwork, and stronger connections with patients and communities.

These factors helped build accountability and encouraged continuous improvement, the authors said.

Government role seen as essential

The study further highlights the important role of government leadership in the success of the SRA programme.

Researchers say the national rollout helped align health facilities around common standards and expectations. However, they caution that implementation approach matters, noting that government ownership was “crucial” to success.

“Changing program administration to non-state actors may compromise success,” the authors warned about shifting responsibility away from the state.

Data and feedback help improve service

Access to data and regular feedback emerged as other key drivers of improvement.

Facilities that routinely reviewed their performance scores were better able to identify gaps and make improvements, the study found.

Resources still matter—but are not enough

While resources such as funding, staffing, and equipment remain essential, the study says they are not sufficient to guarantee better performance.

Facilities with similar resources often achieved very different results, suggesting that internal factors such as motivation and leadership are equally important.

A lesson for health systems beyond Tanzania

Overall, the findings offer important lessons for other countries working to improve healthcare quality, particularly in low-resource settings.

The authors conclude that investments in infrastructure should be matched with efforts to strengthen leadership, motivation, and collaboration within health systems.

Read the publication, here