Practice of emergency obstetric care signal functions and reasons for non-provision among health centers and hospitals in Lake and Western zones of Tanzania

  • BMC Health Services Research, Volume 18, No. 1, Year 2018

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Study Justification:
– The Lake and Western Zones of Tanzania have consistently shown poor Maternal Newborn and Child Health (MNCH) indicators.
– This study aimed to investigate the provision of Emergency Obstetric Care (EmOC) signal functions and reasons for non-provision in health centers and hospitals in these zones.
– The findings of this study can inform policy and decision-making to improve the quality and availability of obstetric care services in the region.
Study Highlights:
– A total of 261 health facilities providing obstetric care services were surveyed in the Lake and Western Zones.
– The three most common EmOC signal functions available were oxytocics, injectable antibiotics, and basic newborn resuscitation.
– The lowest proportions of facilities performed Cesarean section and blood transfusion.
– Policy restrictions, lack of supplies and professional development, and underdeveloped referral services were identified as major challenges in providing EmOC signal functions.
– The direct case fatality rate for direct obstetric causes was 3%.
Study Recommendations:
– Address policy restrictions to ensure that necessary EmOC signal functions, such as blood transfusion and Cesarean section, are provided when needed.
– Improve training and supply availability to enhance the provision of assisted vaginal delivery and uterine evacuation.
– Develop and strengthen referral services to improve the efficiency and effectiveness of the obstetric care system.
Key Role Players:
– Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC)
– Health facility managers and unit in-charges
– Technical committee formed by MOHCDGEC to supervise the research process
– Relevant local authorities
Cost Items for Planning Recommendations:
– Training programs for healthcare professionals
– Procurement and distribution of necessary supplies and equipment
– Development and improvement of referral services
– Research and data collection expenses
– Monitoring and evaluation activities to assess the impact of interventions

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional survey conducted in all 8 regions of the Lake and Western zones of Tanzania in 2014. The study collected information at the health facility level using a standard EmOC tool and included both public and private owned facilities. The data were obtained through interviews, data reviews, and direct observation. The study provides information on the provision of Emergency Obstetric Care signal functions and reasons for non-provision in the two zones. However, the abstract does not provide details on the sample size, sampling method, or statistical analysis conducted. To improve the evidence, the abstract could include more information on the methodology, such as the sample size and sampling method, as well as the statistical analysis conducted to support the findings.

Background: The Lake and Western Zones of Tanzania that encompass eight regions namely; Kagera, Geita, Simiyu, Shinyanga, Mwanza, Mara Tabora and Kigoma have consistently been reported with the poorest Maternal Newborn and Child Health (MNCH) indicators in the country. This study sought to establish the provision of Emergency Obstetric Care (EmOC) signal functions and reasons for the failure to do so among health centers and hospitals in the two zones. Methods: All the 261 public and private hospitals and health centers providing Obstetric Care services in Lake and Western Zones were surveyed in 2014. Data were collected using questionnaires adapted from the Averting Maternal Deaths and Disabilities (AMDD) tool to assess EmOC indicators. Managers in all facilities were interviewed and services, medicines and equipment were observed. Spatial Mapping was done using a calibrated Global Positioning System (GPS) Essential Software for Android and coordinates represented on digitalized map with Arc Geographical Information System (GIS) software. Population data were according to the 2012 Housing and Population National Census. Results: In total 261 health facilities were identified as providers of Obstetric care services, including 69 hospitals and 192 health centres which constitute an overall facility density of 8 per 500,000 population. The three most common EmOC signal functions available in the 3 months preceding the survey were oxytocics (95.7%), injectable antibiotics (88.9%) and basic newborn resuscitation (83.4%). The lowest proportions of facilities performed Cesarean section (25.7%) and blood transfusion (34.6%). Policy restrictions were the most frequent reasons given in relation to nonperformance of blood transfusion and Cesarean section when needed. Lack of training and supplies were the most common reasons for non availability of assisted vaginal delivery and uterine evacuation. Overall the Direct Case fatality Rate for direct obstetric causes was 3%. The referral system highly depended on hired or shared ambulance. Conclusion: The provision of EmOC signal functions in Lake and Western zones of Tanzania is inconsistent, being mainly compromised by policy restrictions, lack of supplies and professional development, and by operating under lowly developed referral services.

This Cross-sectional survey was conducted in all the 8 regions of the Lake and Western zones of Tanzania in 2014. Lake Zone is made up of Mara, Geita, Simiyu, Shinyanga, Mwanza and Kagera regions and the Western zone consists of Kigoma and Tabora regions. According to the Tanzania’s National Population and Housing census of 2012 these two zones had a total population of 16,252, 410 and an area of 233, 837 km 2. The study collected information at the health facility level using a standard EmOC tool which was developed and used by AMDD to assess the availability, use and quality of emergency obstetrics care [8]. For the purpose of mapping, a calibrated Global Positioning System (GPS) Essential Software for Android was used and coordinates represented on digitalized map using Arc Geographical Information System (GIS) software. Although all levels of health facilities were included in the survey, the current analysis is confined to all health centers and hospitals that provide obstetric care services in the two zones including public and private owned facilities. These two types of health facilities belong to the domain of health facilities that are eligible for provision of Comprehensive Emergency Obstetric Care services in Tanzania. The survey primarily aimed at assessing all the original six EmOC indicators [8] in the two study zones whose analysis is still ongoing. The current sub-analysis is limited to Geographical distribution of Obstetric Care health facilities specifically for Health Centres and Hospitals, availability of Emergency Obstetric Care signal functions, and the Direct Case Fatality Rate. Data were obtained from interviews with key people in facilities, data reviews and through direct observation as has been recommended by others [8]. Since interviews with Managers and Unit in-charges was about facility information, only verbal consent was considered necessary after the permission to obtain such data was given by the MOHCDGEC. All data were entered in an electronic questionnaire using android tablets and promptly sent to our central database. In order to ensure quality, a technical committee was formed by the MOHCDGEC which supervised the research process. Throughout the survey access to the data was restricted to the research team. Ethical approval for the study was issued by the NIMR Institutional Research Board. We obtained permission to conduct the study from the relevant local authorities.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health in the Lake and Western zones of Tanzania:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as SMS reminders for prenatal care appointments and medication adherence, can help improve access to maternal health services. These technologies can also provide educational resources and support for pregnant women and new mothers.

2. Telemedicine: Introducing telemedicine services can enable remote consultations between healthcare providers and pregnant women in rural areas. This can help overcome geographical barriers and provide timely access to medical advice and guidance.

3. Training and Capacity Building: Investing in training programs for healthcare providers can help improve their skills and knowledge in emergency obstetric care. This can address the lack of supplies and professional development mentioned in the study, leading to better quality care for pregnant women.

4. Strengthening Referral Systems: Developing a well-coordinated and efficient referral system, including the availability of ambulances, can ensure that pregnant women in need of emergency obstetric care can access appropriate facilities in a timely manner.

5. Public-Private Partnerships: Collaborating with private healthcare providers can help increase the availability of obstetric care services in the region. This can be done through partnerships that provide financial incentives or support for private facilities to offer quality maternal health services.

6. Community Engagement and Education: Conducting community outreach programs and educational campaigns can raise awareness about the importance of maternal health and encourage women to seek timely care. This can help address cultural and social barriers that may prevent women from accessing maternal health services.

It’s important to note that these recommendations are based on the information provided and may need to be further assessed and tailored to the specific context of the Lake and Western zones of Tanzania.
AI Innovations Description
Based on the information provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Policy and Regulations: Address the policy restrictions that hinder the provision of essential maternal health services, such as blood transfusion and cesarean sections. Advocate for policy changes that prioritize and support the availability of these services in health centers and hospitals.

2. Training and Capacity Building: Provide training and professional development opportunities for healthcare providers in the Lake and Western Zones of Tanzania. This will help address the lack of skills and knowledge that contribute to the non-availability of assisted vaginal delivery and uterine evacuation.

3. Supply Chain Management: Improve the availability of essential medicines, equipment, and supplies needed for emergency obstetric care. Develop efficient supply chain management systems to ensure that health centers and hospitals have a consistent and reliable stock of oxytocics, injectable antibiotics, and other necessary signal functions.

4. Referral System Enhancement: Develop a well-coordinated and well-equipped referral system to ensure timely and efficient transfer of pregnant women in need of emergency obstetric care. This could involve improving ambulance services and establishing clear protocols for referral between health centers and hospitals.

5. Technology Integration: Explore the use of technology, such as mobile applications and telemedicine, to enhance access to maternal health services. This could include providing remote consultations and guidance to healthcare providers in underserved areas, as well as facilitating the sharing of information and best practices among healthcare professionals.

By implementing these recommendations, it is possible to improve access to maternal health services in the Lake and Western Zones of Tanzania, ultimately reducing maternal mortality and improving the overall health outcomes for pregnant women in the region.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for improving access to maternal health in the Lake and Western Zones of Tanzania:

1. Strengthen policy and regulations: Address the policy restrictions that hinder the provision of certain emergency obstetric care signal functions, such as blood transfusion and cesarean section. This could involve reviewing and revising existing policies to ensure that they support the availability and accessibility of these services.

2. Improve training and professional development: Address the lack of training and professional development opportunities for healthcare providers in obstetric care. This could involve implementing training programs and workshops to enhance the skills and knowledge of healthcare providers in emergency obstetric care.

3. Enhance the availability of supplies and equipment: Address the lack of supplies and equipment necessary for providing obstetric care services. This could involve improving supply chain management systems, ensuring regular availability of essential medicines and equipment, and exploring partnerships with organizations that can provide necessary resources.

4. Strengthen referral services: Address the challenges related to the referral system, particularly the reliance on hired or shared ambulances. This could involve improving transportation infrastructure, establishing dedicated ambulance services for maternal health emergencies, and strengthening coordination between healthcare facilities for timely referrals.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the availability of emergency obstetric care signal functions, the number of trained healthcare providers, the availability of essential supplies and equipment, and the efficiency of the referral system.

2. Collect baseline data: Gather data on the current status of the identified indicators in the Lake and Western Zones of Tanzania. This could involve conducting surveys, interviews, and observations similar to the methodology described in the provided description.

3. Implement interventions: Implement the recommended interventions, such as revising policies, conducting training programs, improving supply chain management, and strengthening referral services.

4. Monitor and evaluate: Continuously monitor and evaluate the implementation of the interventions and their impact on the identified indicators. This could involve collecting data at regular intervals, conducting surveys and interviews, and analyzing the data to assess the changes in the indicators.

5. Analyze and interpret the data: Analyze the collected data to determine the extent to which the recommendations have improved access to maternal health. This could involve comparing the baseline data with the data collected after the implementation of the interventions and identifying any significant changes or improvements.

6. Adjust and refine: Based on the analysis and interpretation of the data, make any necessary adjustments or refinements to the interventions. This could involve identifying areas that require further improvement or modifications to ensure sustained and continuous improvement in access to maternal health.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health in the Lake and Western Zones of Tanzania and make informed decisions for further interventions and improvements.


Statistics:
Citations: 5
Identifiers:
DOI: 10.1186/s12913-018-3685-6
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Tanzania
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
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