Are Process Indicators Adequate to Assess Essential Obstetric Care at District Level?: A Case Study from Rufiji District, Tanzania

Abstract

To assess coverage and quality of essential obstetric care (EOC) and the appropriateness of using process indicators, a 3-month follow-up study was done in Rufiji district, Tanzania, involving 2 hospitals, 4 health centres, 10 large dispensaries and 10 randomly selected small dispensaries. Data collection was done on process indicators as suggested by UNICEF/ WHO/UNFPA (UN) and 'unmet obstetric need (UON) for major obstetric intervention (MOI)'. With standard values in (brackets), the district had two comprehensive EOC facilities, births in EOC amounted to 62% (15%), met need for EOC was 76% (100%), caesarean section (C/S) rate 4.1% (>5%), hospital case fatality rate (CFR) 1.0% (<1%) and successful obstetric referrals 46% (100%). MOI for absolute maternal indication in the district was 2.6% (1-2%). All four maternal deaths occurred due to transport failures. The process indicators gave contradictory impressions on the coverage and quality of care and failed to link to the outcome of delivery complications in the study. RÉSUMÉLes indicateurs du processus sont-ils adéquats pour évaluer le soin obstétrique essential au niveau du district? Une étude de cas du district de Rufiji, Tanzaniae Afin d'évaluer l'étendue et la qualité du soin obstétrique essentiel (SOE) et le caractère approprié de l'emploi des indicateurs de processus, une étude d'une durée de trois mois qui est basée sur des suivis médicaux, a été menée dans le district de Rufiji, Tanzanie, auprès de deux hôpitaux, quatre centres médicaux, diz grandes pharmacies et dix petites pharmacies selectionnées au hasard. Les données ont été recueillies à l'aide des indicateurs du processus comme l'ont préconisé l'UNICEF/OMS/UNFPA(ONU) et "le besoin obstétrique nonsatisfait (BON) à propos des interventions obstétriques principales (IOP)". Avec les valeurs normales (entre guillemets) le district disposait de deux structures de SOE, le taux de naissance par rapport au SOE s'est élevé à 62%(15%), le taux du besoin non-satisfait par rapport au SOE était de 76%(100%), le taux d'opération césarienne (OC) était de 4,1%(<5%), le taux du dècès des patients à l'hôpital (TDH) 1,0% (<1%) et les orientations vers les services spécialisés étaient de 46% (100%). L'IOP par rapport à l'indication maternelle absolue dans le district était de 2,6% (1-2%). Tous les quartre dècès maternels se sont produits à cause du manque de transport. Les indicateurs du processus ont signalé des impressions contradictoires en ce qui concerne la coverture et la qualité de soin et ils n'ont pas pu se lier au résultat des complications liées à l'accouchement dans l'étude. (Rev Afr Santé Reprod 2005; 9[3]:100-111) KEY WORDS: Quality of obstetric care, met needs, process indicators, program evaluation, Africa.

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