2018 Health and Social Protection Other

Closing the Quality Gap – Investigating Health System Bottlenecks and Quality Improvement Strategies for Maternal and Newborn Care in Sub Saharan Africa, Focusing on Tanzania

Ulrika Baker

Maternal and newborn deaths and stillbirths remain high in Sub Saharan Africa. Despite the large increases achieved in access to care, the expected gains in survival for mothers and newborns have therefore not materialised, giving rise to the concept of a quality gap. The contribution of this thesis was to provide an understanding of its underlying causes, to develop and apply approaches to measure its characteristics and to evaluate quality improvement strategies to address it.

The report was presented during the seminar Overcoming Barriers to Sexual and Reproductive Health and Rights.


  • Support strengthening and use of health information to reflect quality of care and to enable identification of bottlenecks.
  • Target unpredictability within health systems and promote health programmes that can be supported reliably and sustained over time.
  • Support countries to achieve greater coordination of programs implemented by external partners, especially at the district level.
  • Promote contextually appropriate improvement strategies through prioritising health workers’ need for support in every day practice.

Ulrika Baker is a Medical Doctor with a background in Public Health and Family Medicine. She has lived and worked for several years in Sub Saharan Africa, including in Tanzania, Uganda, Eritrea and Malawi where she has been based since 2016. Her research interests include implementation of health services and quality of care in low resourced settings, especially for mothers, newborns and adolescents. This Development Dissertation Brief is a summary of Ulrika’s doctoral thesis, which she defended at the Department of Public Health Sciences, Karolinska Institutet in April 2017.