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Background: Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).Methods: In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach.Results: Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation.Conclusion: The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds. © 2014 Mkoka et al.; licensee BioMed Central Ltd.
The study was conducted in Kongwa, a typical rural district in Dodoma region which had a total population of about 309,973 people in 2012 [30]. The two main ethnic groups found in this district are Gogo and Kaguru. Common occupations include subsistence farming and small scale trading. The district has one hospital, four rural health centers and 32 dispensaries that conduct delivery services. Many health facilities are accessed by unpaved rural roads, which are not easily passable during the rainy seasons. All these facilities provide antenatal care (ANC) and offer delivery services. Caesarean sections are provided at one rural health center and at the district hospital. Different methods were used to collect data for this study. These included in-depth interviews with facility health managers, a survey of selected heath facilities and a desk review of existing/available documents. In depth interviews guides were designed to collect the views of facility managers on their experience of ensuring the timely availability of drugs and medical supplies for EmOC. In April and May 2012 a total of 17 health facility managers were interviewed: 14 from the dispensaries and three from health centers. Furthermore, two members of the CHMT and one member of the CHSB were also interviewed on their experiences of the drug funding mechanism for the health facilities. The facilities where respondents came from were purposively selected from three wards (Mkoka, Mlali, Ugogoni) to reflect the geographical diversity of the study. Respondents were also selected purposively to include those involved in drug ordering and reporting using ILS. The two CHMT members, the District Medical Officer and District Pharmacist and a chairperson of the CHSB were interviewed because of their involvement in the approval of funds for drug procurement at the district level. The first author together with the research assistant collected data and all interviews were audio-taped; field notes and memos were written up both during and immediately after the interviews. The interviews followed a semi-structured format, and the following aspects were explored: availability of drugs and medical supplies and its effect on care, focusing on EmOC; the accessibility of complementary drug funds; and community and staff reactions to drug shortages. During April 2012, 18 government-owned facilities were surveyed by the first author with the aim of understanding the existing situation with regard to the availability of drugs and supplies needed for EmOC. At each visited facility, observation and assessment were conducted by interviewing facility managers using a facility survey guide. The researcher interviewed facility managers about aspects of human resources, infrastructure, availability of drugs and medical supplies, and their experience of deliveries. The data collected during the interviews were validated by observation of the facility drug storage rooms and informal discussion with facility managers, staffs and user representatives at some of the facilities. In particular, the observation during the facility survey was focused on the presence or absence of essential drugs and medical supplies for EmOC. Audio-taped interviews were transcribed by the first author and translated from Swahili into English. The transcripts together with the expanded field notes were the main data used for analysis. To ensure familiarization with the data, multiple readings of the transcript and expanded notes were conducted and data were analyzed using thematic analysis [31]. Thematic questions were preselected and the parts of the text that referred to those questions were marked and coded. Similar codes considered pertinent to the preset research question were grouped to form subthemes and similar subthemes formed a theme. The emerged themes were then shared among other authors and a consensus was reached about the various themes and how they fitted together. Data from document reviews and health facility surveys were used as supporting information in clarifying the concepts that emerged during thematic analysis. This study was approved by the review body of Muhimbili University of Health and Allied Sciences (MUHAS). Permission to conduct the study in Kongwa district was given by Dodoma Regional Administrative Secretary (RAS). Written consent to visit facilities was obtained from the District Medical Officer’s (DMO) office, the District Executive Director’s (DED) office and the District Administrative Secretary’s (DAS) office. Informed consent to participate was obtained from the participants after assurances of anonymity and confidentiality were given.
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