Basic Accountability to Stop Ill-Treatment (BASI); Study Protocol for a Cluster Randomized Controlled Trial in Rural Tanzania

Background: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa there is a growing body of evidence of poor quality that in some cases goes as far as disrespectful or abusive care. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience. The patient experience includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support. Methods/Design: This cluster-randomized controlled study will randomize 75 primary health care facilities in rural Pwani Region, Tanzania to one of three arms: private feedback (intervention), social recognition reward (intervention), or no feedback (control). Within both intervention arms, we will give the providers at the study facilities feedback using the baseline data. Facilities randomized to the social recognition reward arm will also have a star-chart displaying their achieved level of patient experience publicly posted and potential recognition from senior officials at the local NGO and/or the Ministry of Health. We will use surveys with parents/guardians of sick children to measure patient experience, and surveys with healthcare providers to assess potential mechanisms of effect. Conclusion: Results from this study will provide evidence for whether, and through what mechanisms, patient reported feedback can affect interpersonal quality of care. Pan African Clinical Trials Registry: 201710002649121