There are bugs in condoms: Tanzanian close-to-community providers’ ability to offer effective adolescent reproductive health services

  • Journal of Family Planning and Reproductive Health Care, Volume 41, No. 1, Year 2015

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Study Justification:
– The study aimed to investigate the capacity of close-to-community providers in Tanzania to offer effective adolescent reproductive health services.
– It aimed to address questions about the quality of services provided by these providers and their readiness to integrate with the mainstream health sector.
– The study focused on determining which cadres of providers were offering reproductive services to adolescents, the services they offered, their skills and capacity, and their attitudes towards adolescent reproductive health.
Highlights:
– The study was conducted in nine communities in two districts in Mwanza Region, Tanzania.
– It included close-to-community providers from various settings such as drug stores, village AIDS committees, traditional healers, and traditional birth attendants.
– Formal health service providers from government dispensaries and health centers were also included for triangulation.
– Cadre-specific focus group discussions were conducted to capture the consensus view on experiences and attitudes towards adolescent reproductive health.
– Ethical approvals were obtained, and informed written consent was sought from all participants.
– The discussions were digitally recorded, transcribed, and analyzed using NVivo™ 9 Software.
Recommendations:
– Based on the findings, it is recommended to strengthen the capacity of close-to-community providers in offering adolescent reproductive health services.
– Efforts should be made to improve their skills and knowledge in family planning, contraception, antenatal care, maternal delivery, HIV and STI prevention and treatment, and post-abortion care.
– Collaboration and referral systems between close-to-community providers and formal health facilities should be established to ensure comprehensive and integrated care for adolescents.
– Training programs and supportive supervision should be provided to close-to-community providers to enhance their ability to offer quality services.
Key Role Players:
– Close-to-community providers (e.g., drug store owners, village AIDS committee members, traditional healers, traditional birth attendants)
– Formal health service providers (e.g., government dispensaries, health center staff)
– Researchers and senior researchers from the Tanzania National Institute for Medical Research (NIMR) Mwanza
– Administrative leaders at the regional, district, and ward levels
– Ethical committees and research coordinating committees
Cost Items for Planning Recommendations:
– Training programs for close-to-community providers
– Supportive supervision and mentoring
– Development of referral systems and collaboration mechanisms
– Communication and coordination activities between close-to-community providers and formal health facilities
– Monitoring and evaluation of the implementation of recommendations
– Research and data analysis costs

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study investigates the capacity of close-to-community providers to offer adolescent reproductive health services in Tanzania. It includes focus group discussions with participants from different cadres and triangulates views with formal health service providers. The study also obtained ethical approvals and informed consent from participants. However, the abstract does not provide information on the sample size or the specific findings of the study. To improve the evidence, the abstract could include more details on the methodology, sample size, and key findings.

Objectives Young people in Tanzania are known to access reproductive health services from a range of close-to-community providers outside formal health settings such as drug stores, village AIDS committees, traditional healers and traditional birth attendants (TBAs). However, questions remain about the quality of services such agents provide. This study investigated their capacity to provide adolescent reproductive health (ARH) services and explored their readiness and ability to integrate with the mainstream health sector through community referral interventions.

We aimed to determine which cadres of close-to-community providers were providing reproductive services to adolescents in nine communities in two districts (Magu and Sengerema) in Mwanza Region on the northwest shore of Lake Victoria; what services they offered; their skills and capacity to provide them; their attitudes towards ARH; and their attitudes to cooperation with the mainstream health sector, especially referral of their clients to formal health facilities. These providers were selected from communities that were stratified into rural, urban and high-risk clusters. We also included formal health service providers from government dispensaries and health centres to triangulate views on community referral and integration. Cadre-specific focus group discussions (FGDs) with 8–14 participants were conducted in order to capture the consensus view on the respective experiences and attitudes17 18 to ARH. FGDs were facilitated by senior researchers from the Tanzania National Institute for Medical Research (NIMR) Mwanza. The FGDs were conducted in February 2011 at central locations (e.g. schools, health centres or village offices). Village executive officers invited eight people per cadre to participate in planned FGDs; however, word-of-mouth spread of information about the study led to greater numbers of participants than expected. In view of the distance they had travelled, additional participants could not be turned away. Ethical approvals were obtained from the Liverpool School of Tropical Medicine Research Ethics Committee and the Tanzania Medical Research Coordinating Committee. Permission was obtained from administrative leaders at the regional, district and ward levels, and informed written consent was sought from all participants. FGD guides were prepared, pretested in the field and revised to incorporate the views of pre-test participants. Discussion focused on skills, attitudes and practices in family planning and contraception, antenatal care and maternal delivery, HIV and STI prevention and treatment as well as post-abortion care. After each round of discussion the guide was further tuned to key themes based on reflection on the previous FGDs. The discussions were digitally recorded, transcribed in Kiswahili language and translated into English. Using NVivo™ 9 Software (QSR International, Doncaster, Victoria, Australia), the transcripts were analysed using a thematic framework based on nodes that were deductively drawn from predefined themes in the discussion guide.19

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Based on the provided information, it seems that the study focused on assessing the capacity of close-to-community providers to offer adolescent reproductive health services and their readiness to integrate with the mainstream health sector through community referral interventions. The study used focus group discussions to gather information from different cadres of providers.

In terms of innovations to improve access to maternal health, based on the information provided, it is not explicitly mentioned. However, some potential recommendations could include:

1. Strengthening training and capacity building: Provide comprehensive training programs for close-to-community providers, including traditional birth attendants, on adolescent reproductive health services. This can help improve their skills and capacity to provide quality services.

2. Integration with the mainstream health sector: Promote collaboration and cooperation between close-to-community providers and formal health facilities. This can involve establishing referral systems and protocols to ensure seamless access to maternal health services for adolescents.

3. Community awareness and education: Implement community-based awareness campaigns to educate adolescents and their families about the importance of maternal health and the available services. This can help reduce stigma and increase demand for services.

4. Mobile health (mHealth) interventions: Utilize mobile technology to provide information, reminders, and support to adolescents and close-to-community providers. This can include text messaging services for appointment reminders, educational materials, and access to teleconsultations.

5. Quality assurance mechanisms: Establish mechanisms to monitor and evaluate the quality of services provided by close-to-community providers. This can include regular assessments, feedback mechanisms, and continuous quality improvement initiatives.

It is important to note that these recommendations are based on general principles and may need to be adapted to the specific context and needs of the communities in Tanzania.
AI Innovations Description
Based on the information provided, the study aimed to assess the capacity of close-to-community providers in Tanzania to offer adolescent reproductive health (ARH) services and their readiness to integrate with the mainstream health sector through community referral interventions. The study focused on determining which cadres of providers were offering reproductive services to adolescents, the services they provided, their skills and capacity to provide them, their attitudes towards ARH, and their attitudes towards cooperation with the mainstream health sector.

To improve access to maternal health, the following recommendation can be developed into an innovation:

1. Strengthening the capacity of close-to-community providers: Based on the findings of the study, it is important to invest in training and capacity-building programs for close-to-community providers to enhance their skills and knowledge in providing maternal health services. This can include training on antenatal care, safe delivery practices, postnatal care, and family planning.

2. Integration of close-to-community providers with the mainstream health sector: To improve access to maternal health, close-to-community providers should be integrated into the formal health system. This can be achieved through referral systems and collaboration between close-to-community providers and government dispensaries and health centers. This integration will ensure that pregnant women and new mothers receive comprehensive and coordinated care throughout the continuum of maternal health services.

3. Community awareness and education: It is crucial to raise awareness and educate the community, especially adolescents, about the importance of maternal health and the services available. This can be done through community outreach programs, health education campaigns, and the involvement of community leaders and influencers. By increasing awareness and knowledge, more individuals will seek maternal health services and utilize the services provided by close-to-community providers.

4. Monitoring and evaluation: To ensure the effectiveness of the innovation, a robust monitoring and evaluation system should be established. This will help track the progress, identify gaps, and make necessary adjustments to improve the quality and accessibility of maternal health services. Regular monitoring and evaluation will also provide valuable data for evidence-based decision-making and policy development.

By implementing these recommendations, the innovation can improve access to maternal health by strengthening the capacity of close-to-community providers, integrating them with the mainstream health sector, raising community awareness, and establishing a monitoring and evaluation system.
AI Innovations Methodology
Based on the provided description, the study aimed to investigate the capacity of close-to-community providers in Tanzania to provide adolescent reproductive health (ARH) services and their readiness to integrate with the mainstream health sector through community referral interventions. The study collected data through cadre-specific focus group discussions (FGDs) with close-to-community providers and formal health service providers.

To improve access to maternal health, here are some potential recommendations:

1. Strengthening the capacity of close-to-community providers: Provide training and resources to close-to-community providers to enhance their skills and knowledge in providing maternal health services. This can include training on antenatal care, safe delivery practices, postnatal care, and family planning.

2. Promoting collaboration and referral systems: Establish effective referral systems between close-to-community providers and formal health facilities. This can involve creating clear communication channels, developing referral protocols, and fostering collaboration between providers to ensure seamless transfer of patients when necessary.

3. Increasing community awareness and engagement: Conduct community outreach programs to raise awareness about the importance of maternal health and the services available. This can involve organizing community meetings, conducting health education sessions, and utilizing community health workers to disseminate information.

4. Improving access to essential supplies and equipment: Ensure that close-to-community providers have access to necessary supplies and equipment for maternal health services. This can include providing them with basic medical equipment, contraceptives, and essential drugs.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Baseline data collection: Gather information on the current status of maternal health access in the target communities. This can include data on the number of maternal deaths, antenatal care coverage, facility-based deliveries, and contraceptive use.

2. Intervention implementation: Implement the recommended interventions in selected communities. This can involve training close-to-community providers, establishing referral systems, conducting community awareness campaigns, and ensuring the availability of essential supplies.

3. Monitoring and evaluation: Regularly monitor and evaluate the impact of the interventions on improving access to maternal health. This can include collecting data on changes in maternal health indicators, such as the reduction in maternal mortality rates, increase in facility-based deliveries, and improvement in contraceptive uptake.

4. Comparative analysis: Compare the data collected after the intervention with the baseline data to assess the impact of the recommendations. This can involve statistical analysis to determine the significance of the changes observed.

5. Feedback and adjustment: Based on the findings, provide feedback to stakeholders and make necessary adjustments to the interventions. This can involve refining the training programs, modifying referral systems, or adapting community engagement strategies.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health and assess their effectiveness in the target communities.


Statistics:
Citations: 7
Identifiers:
DOI: 10.1136/jfprhc-2014-100915
ISSN: 14711893
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Tanzania
Study Approach:
Qualitative
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