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The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania.

A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs.

Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months.

The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures.

Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

The purpose of this paper is to present the role of reflexivity in relation to archives and narratives.

The authors problematize the concept of “archive,” by engaging with debates in philosophy and the archival theory. The authors also revisit historical theories and debates on the role of the narrative within historiography. Finally, the authors consider reflexivity as a methodological attitude taken by the researcher at all stages of the investigation from challenging theoretical assumptions of empirical materials to questioning the very narrative that is created when looking for alternative ones.

This paper poses questions about documents and archives that emerge from reflexivity. The authors claim that reflexivity is an ethos that allows researchers to keep the multiple narratives in which they are entangled in check. The paper brings a framework that allows researchers to use reflexivity to become more conscious of the complexities and ambiguities within the research process that leads to the writing of historical narratives.

This paper points to the need to enhance the reflexivity at every stage of the research, including “interrogating” the archives and documents, which are compiled under a narrative.

The authors highlighted the multiple characteristics of archives, their meanings and the possibilities of writing narratives about them through reflexivity. The authors have the historical narrative as one possible reconstruction of a historical object, which is connected to the production conditions of the text. Through reflexivity, the authors discussed the socially constructed nature of the documents and the archives. Finally, the authors believe that debates around the production of this knowledge should continue, focusing especially on building bridges with the field of history.

Historical narratives do not depend on the scientific character of historical sources, but it considers reflexivity by the researcher regarding the search, collection, reading and analysis of historical documents. In addition, it is necessary to think about the use of documents and archives and histories in a reflective way for a writing of history and, indirectly, for a contextual understanding of the time observed and as forged sources – or discarded – and made available.

Challenging the use of documents and archives in a reflexive way for the writing of historical narratives and for contextual understanding of the past is key to a richer relationship between management and history. This paper points to the role of reflexivity in relation to archives and narratives in the practice of (re)constructing the organizational past from memories and silences. It also highlights how reflexivity can be incorporated in the research process to enrich the writing of the historical narrative.