Health facility service availability and readiness to provide basic emergency obstetric and newborn care in a low-resource setting: evidence from a Tanzania National Survey

Abstract

ObjectiveThis study used a nationally representative sample from Tanzania as an example of low-resource setting with a high burden of maternal and newborn deaths, to assess the availability and readiness of health facilities to provide basic emergency obstetric and newborn care (BEmONC) and its associated factors.DesignHealth facility-based cross-sectional survey.SettingWe analysed data for obstetric and newborn care services obtained from the 2014–2015 Tanzania Service Provision Assessment survey, using WHO-Service Availability and Readiness Assessment tool.Primary and secondary outcome measuresAvailability of seven signal functions was measured based on the provision of ‘parental administration of antibiotic’, ‘parental administration of oxytocic’, ‘parental administration of anticonvulsants’, ‘assisted vaginal delivery’, ‘manual removal of placenta’, ‘manual removal of retained products of conception’ and ‘neonatal resuscitation’. Readiness was a composite variable measured based on the availability of supportive items categorised into three domains: staff training, diagnostic equipment and basic medicines.ResultsOut of 1188 facilities, 905 (76.2%) were reported to provide obstetric and newborn care services and therefore were included in the analysis of the current study. Overall availability of seven signal functions and average readiness score were consistently higher among hospitals than health centres and dispensaries (p<0.001). Furthermore, the type of facility, performing quality assurance, regular reviewing of maternal and newborn deaths, reviewing clients’ opinion and number of delivery beds per facility were significantly associated with readiness to provide BEmONC.ConclusionThe study findings show disparities in the availability and readiness to provide BEmONC among health facilities in Tanzania. The Tanzanian Ministry of Health should emphasise quality assurance efforts and systematic maternal and newborn death audits. Health leadership should fairly distribute clinical guidelines, essential medicines, equipment and refresher trainings to improve availability and quality BEmONC.

Incidence and Predictors of Maternal and Perinatal Mortality among Women with Severe Maternal Outcomes: A Tanzanian Facility-Based Survey for Improving Maternal and Newborn Care

“…e current study buttresses this evidence, as we found out that postpartum hemorrhage and hypertensive disorders are the major leading causes of MD among women with SMO in Tanzania. e persistent high number of women dying due to these conditions might be due to the inadequate availability and readiness of the lower-level and public facilities in Tanzania to provide basic emergency obstetric and newborn care (BEmONC) [29,30]. Similar findings have been reported in other previous studies conducted in Tanzania [14,15] and other areas with similar setting [25,31,32].…”

“…is might be explained by the fact that there is no separate adult ICU for critically ill obstetric patients at DRRH. Together with the reported inadequate availability of BEmONC among Tanzania health facilities [29,30], these might compromise the provision of ICU services. Equally, in majority of health facilities in Tanzania, adult ICUs have a limited number of patients' beds and only those who are critically ill are admitted.…”

Supply Side Readiness for Universal Health Coverage: Assessing Service Availability and Barriers in Remote and Fragile Setting.

“…Subcenters and new type primary health centers were particularly low performing and invariantly had less readiness Vis a Vis hospitals. Same findings reverberates through other studies across different regions in LMICs where hospitals were found to report significantly greater input availability and concentration of resources than health centers and dispensaries (Bintabara et al, 2019;Ssempiira et al;Winter et al;2017;Iyer et al, 2015;Boyer et al,2015). The challenges confronting peripheral rural institutions are vexed ranging from workforce shortage, poor monitoring and evaluation, suboptimal budgetary allocation and lack of community participation.…”

Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

“…A similar national level health facility survey conducted in Tanzania in 2014-2015, showed that hospitals had better readiness and availability of services than health centres for delivery. Those hospitals which had quality improvement systems for care delivery had better readiness to provide basic emergency and obstetric care (Bintabara et al 2019). A study conducted in Malawi to assess the association of health facility readiness to the quality of newborn showed that health facilities which had better preparedness for delivery and newborn care with equipment The introduction of free institutional delivery and demand side financing for institutional delivery in the last 15 years in Nepal led to a fourfold increase in the proportion of deliveries occurring in health institutions (Ministry of Health and Population Nepal, New ERA, and ICF International 2007;Ministry of Health and Population, and ICF International 2012;Ministry of Health, Nepal 2017;Raven et al 2011).…”