Getting the numbers right

Power, creativity and 'good' routine maternal and neonatal health data in Southern Tanzania

Datos Bibliográficos

ID4601331
AutoresJil Molenaar (0000-0002-4154-6478, Instituut voor Tropische Geneeskunde), Amani Kikula (0000-0002-1130-9279, Instituut voor Tropische Geneeskunde), J Van Olmen (0000-0001-9724-1887, University of Antwerp), Andrea Pembe (0000-0002-8090-3298, Muhimbili University of Health and Allied Sciences), Lenka Beňová (0000-0001-8595-365X, Instituut voor Tropische Geneeskunde)
Año2025
Volumen366
Páginas117668
Fecha de publicación2025-02-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Science & Medicine (JOURNAL)
Identificadores de la revistaISSN: 0277-9536 • E-ISSN: 1873-5347
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2024.117668
PMID39787826
OpenAlexW4406011645
IdiomaEN
Citas recibidas3
Referencias citadas37

What makes routine maternal and neonatal health data to be 'good quality'? That depends on whom you ask - the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards of two hospitals in Southern Tanzania. We draw from focused ethnographic observation at these two labour wards 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 maternal and neonatal health 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 act creatively 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. HCWs may hereby compromise their own definitions of 'good' data, and as as consequence, limit the usefulness of routine data to inform clinical decision making and health system planning. We underline the importance of supportive supervision, feasibility and perceived relevance of routine health data for those tasked to collect and report it, in order to better navigate the blurry line between constructive accountability and counter-productive pressure

Child health · Creativity · Developing country · Economic growth · Economics · Environmental health · Power (physics · Socioeconomics · Sociology · Tanzania · Child Nutrition and Water Access · Global Health and Surgery · Global Maternal and Child Health · Medicine · Psychology · Social Psychology · Pediatrics