Getting the Numbers Right: Power, Creativity and ‘Good’ Routine Maternal and Neonatal Health Data in Southern Tanzania

Jil Molenaar, Institute of Tropical Medicine, Antwerp
Amani Kikula, MUHAS
Josefien van Olmen, University of Antwerp
Andrea Barnabas Pembe, Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam
Claudia Hanson, Health Systems and Policy | Global Public Health | Karolinska Institutet
Lenka Benova, Institute of Tropical Medicine, Antwerp

This qualitative study analyses the power dynamics shaping how routine maternal and neonatal health data are collected and reported in two hospitals’ labour wards in Southern Tanzania. We draw on focused ethnographic observation and 29 in-depth qualitative interviews with health care workers (HCWs), hospital leaders, and relevant district- and regional-level managers. We distinguish between two different types of power that shape how people engage with routine maternal and neonatal health data: authoritative and discretionary power. Authoritative power, or top-down power ‘over’, is reflected in how targets and measurement demands are imposed on individuals lower in the power hierarchy. We show how this results in an environment where data are seen as ‘political things’ and where HCWs feel pressured and fear being blamed for poor health outcomes. Yet, data can also be a means for HCWs to exercise discretionary power – a type of bottom-up power to deflect scrutiny and protect themselves and others. Strategically handling and manipulating data, HCWs ‘get the numbers right’ by balancing their own needs, top-down expectations, and structural challenges. In doing so, HCWs may compromise their own definitions of ‘good’ data, and curtail the usefulness of routine data to inform clinical decision-making and health system planning.

Keywords: Qualitative data/methods/approaches, Sexual and Reproductive Health and Rights, Data and Methods, Health and Morbidity

See extended abstract.