Maternal Health Services in Tanzania: Strengths and Weaknesses of Different Levels of Health Facility

7/29/2019 Maternal Health Services in Tanzania: Strengths and Weaknesses of Different Levels of Health Facility

1/13

Dunstan BishangaChief o f Party

MAISHA Program

Maternal hea lth services inTanzania : strengths and

weaknesses of d ifferentlevels of health fac ility


2/13

Background

Close to half of deliveries in

Tanzania occur at home, but SBA

in facilities gradually increasing

41% of all deliveries in 1999,

51% in 2010

Quality of care critical to increase

attendance of deliveries of

women in health facilities

Interpersonal skills particularly

important


3/13

Background

Quality of BEmONC services assessed in joint

MOHSW / MAISHA assessments in 2010 and 2012

52 health facilities in Tanzania assessed, including 12regional hospitals and 40 health centres/ dispensaries

In 2010, n=489 deliveries observed; in 2012, n=555


4/13

Background

2012 results showed dramatic improvements.

Many indicators showed noted differences between

regional hospitals and lower level health facilities

Persistent gaps included: use of oxytocin (rather than

other uterotonic) for AMTSL; receiving uterotonic within1 minute of delivery; allowing a support person, andmonitoring of vital signs after delivery


5/13

AMTSL with (Oxytoc in within 1min+CCT+Uterine Massage)

Notable increase oc curred be tween 2010 and 2012 on use ofoxytoc in for AMTSL in lower level HF from 55% of observeddeliveries in 2010 to 83% in 2012. Gap between levels stillstatistically significant

33%

8%

26%

47%39%

44%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

HOSPITALS HC/DISP ALL

2010 2012


6/13

Uterotonic within 1 minute of delivery

% correctly

performed(regional hospitals)

% correctly

performed (healthcenters/

dispensaries)

Statistical

significance

(Fishers

Exact Test)

2010 35 11 P=0.001

2012 56 45 P=0.0205

Dramatic increase occurred between 2010 and 2012on administration of uterotonic within 1 minute ofdelivery, but gap still statistically significant

Received uterotonic within one minute of delivery

Relaxed definition: regional hospitals: 70%, HC/disp: 56%


7/13

Oxytoc in for AMTSL

Dramatic increase occurred between 2010 and 2012 on use ofoxytocin for AMTSL. Gap between levels still statisticallysignificant.

AMTSL was done with oxytocin

% deliveriesobserved

(regional

hospitals)

% deliveriesobserved

(health centers/

dispensaries)

Statisticalsignificance

(Fishers Exact

Test)

2010 31% 8% P=0.001

2012 48% 37% P=0.02


8/13

Ask about support person

In both 2010 and 2012, lower level health facilities were morelikely to ask the woman if she had a support person. Theproportion for Regional hospitals increased dramatically in2012, but the difference is still statistically significant.

Provider asks about support person at initial assessment

% deliveries observed

(regional hospitals)


(health centers/

dispensaries)

2010 27 48

2012 40 50


9/13

Sc reening for PE/ E in initia l assessment

Dramatic increases were seen at both levels for screening forPE/E*composite indicator, includes asking about symptoms andchecking for other signs

Provider asks about support person at initial assessment


(regional hospitals)


(health centers/

dispensaries)

2010 29 27

2012 59 50


10/13

Interpersona l communication indicators in

2012

Indicator % deliveriesobserved (regional

hospitals)


(health centers/

dispensaries)

Statistical significance

(Fishers Exact Test)

Counseling for iron/ folic

acid in ANC

16% 54% 0.000

Counseling on malaria in

ANC

62% 77% 0.03

HW asks about

complications during

initial assessment (L&D)

42% 77% 0.03

On several IPC indicators, lower level health facilities were significantlymore likely to have better IPC. Ex. More women got counseled onFe/Fo and malaria in ANC


11/13

Conc lusion/ Rec ommendations

Prevention of PPH, screening for PE/E dramatically

increased; differences in provision of AMTSL

remain persistent across levels of HF

Lower level health care facilities are lesscrowded and could potentially provide more friendly

services

Higher level health care facilities demonstrate

better clinical practices

Work to address factors that make one level do

better than the other


12/13

Conc lusion/ Rec ommendations

Quality maternal health care is every woman s right,

a t every level of the hea lth system. Ad herence to

na tiona l c linic a l standards must be observed by a ll

p roviders no matter whic h level

Supportive supervision and othe r qua lity

improvement measures should be utilized in order

to ac hieve high qua lity ma terna l hea lth servic es a ta ll leve ls of the hea lth system


13/13

Acknowledgements

This presentation is made possible by the generous support of the American peoplethrough the United States Agency for International Development (USAID)Cooperative Agreement No. 621-A-00-08-00023-00. The contents are theresponsibility of the Mothers and Infants, Safe Healthy Alive (MAISHA) program anddo not necessarily reflect the views of USAID or the United States Government.

Authors: Dunstan Bishanga; Gaudiosa Tibaijuka;Christina Makene; Marya Plotkin; Sheena Currie;;Maryjane Lacoste

Institutions: Reproductive and Child Health Section, Ministry ofHealth and Social Welfare, Tanzania; Jhpiego Tanzania; JhpiegoWashington DC

Documents

Maternal Health Services in Tanzania: Strengths and Weaknesses of Different Levels of Health Facility