Correlation of Obstetric Care Facility Density with Standard Emergency Obstetric and Neonatal Care Indicators in Tanzania Mainland

Abstract

Tanzania's Primary Health Services Development Program (PHSDP) started in 2007 with the aim to establish and staff an additional 5162 dispensaries, 2074 health centres and 8 district hospitals by 2017 which would implicitly increase obstetric care facility density. However, currently obstetric care facility density is not a standard Emergency Obstetric and Neonatal Care (EmONC) indicator and data on its correlation with the standard EmONC indicators is scanty. In 2015 a crosssectional survey of all hospitals, health centres and a random sample of dispensaries providing delivery services in all the 25 regions of Tanzania Mainland was conducted whereby the presence of EmONC functions in past 3 months was assessed using a standard tool. Where necessary, population data were based on the 2012 National housing and population Census and the 2010 Tanzania Demographic Health Survey (TDHS). Data were analyzed using IBM SPSS version 20 and STATA. Spatial Mapping was done using a calibrated Geographic Positioning System (GPS) Essential Software for Android and coordinates represented on digitalized map with Arc Geographic Information System (GIS). Ethical approval was granted by the Ethical Clearance Committee of Medical Research Council [MRCC], National Institute for Medical research. Of the confirmed 5207 obstetric care facilities 2405 (46.2%) were surveyed including 35.3% of all dispensaries. National Obstetric care facility density was 68/ 500,000 population, 7/500,000 of them provided all the 7 Basic Emergency Obstretic and Neonatal Care (BEmONC) functions in past 3 months. Among all the regions, 40% had attained or exceeded the international benchmark for EmONC facilities per 500,000 population. Institutional delivery rate was 79% and overall Caesarean Section rate was 5.6%. Improved obstetric care facility density was strongly correlated with improved institutional delivery; Caesarean section rate and met need for EmONC but not the quality of case management. In conclusion obstetric care facility density is well correlated with other standard EmONC indicators.

Migration for obstetric care: the impact of regional Obstetric Care Facility Density disparities in Tanzania

“…The denominator was calculated for each region from the total population with its Crude birth rate, both obtained from Tanzania Bureau of Statistics based on the 2012 Population and Housing Census. The survey was conducted in all obstetric care facilities in Tanzania Mainland in 2015 whose details are given in the previous publications [ 4 , 5 ]. Obstetric care facilities included dispensaries, health centres and hospitals responsible for provision of maternity care and delivery services.…”

“…The UN process indicators have been blamed for inability to capture spatial aspects of EmONC service availability and failure in capturing an important role played by other obstetric care facilities in an area not qualifying as EmONC [ 3 ]. Although OCFD is not one of the UN process indicators, it is a proxy to spatial distribution of obstetric care services and encompasses the contribution of all obstetric care facilities in a geographical area regardless of their EmONC statuses [ 1 , 3 , 4 ]. In a National Survey of EmONC indicators in Tanzania in 2015, overall OCFD was shown to be strongly correlated with institutional delivery [ 4 ].…”

“…Although OCFD is not one of the UN process indicators, it is a proxy to spatial distribution of obstetric care services and encompasses the contribution of all obstetric care facilities in a geographical area regardless of their EmONC statuses [ 1 , 3 , 4 ]. In a National Survey of EmONC indicators in Tanzania in 2015, overall OCFD was shown to be strongly correlated with institutional delivery [ 4 ]. Moreover, among the 25 regions, four had institutional deliveries in excess of 100% of the expected.…”

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

“…It has been consistently shown in various studies that the Lake and Western zone regions especially Mara, Mwanza, Shinyanga, Geita, Simiyu, Kigoma and Tabora have been left out with a big gap in many EmOC and Reproductive health indicators [ 3 , 5 , 10 – 14 ]. Moreover, reports by the Ministry of Health Community Development Gender, Elderly and Children (MOHCDGEC) indicate a serious Human Resource for Health shortage in the country but being the poorest in all the regions of Lake and Western zones [ 12 , 15 ].…”

“…Moreover, reports by the Ministry of Health Community Development Gender, Elderly and Children (MOHCDGEC) indicate a serious Human Resource for Health shortage in the country but being the poorest in all the regions of Lake and Western zones [ 12 , 15 ]. Apart from poor Human Resource for Health, a recent National survey has also reported the two zones as among three zones in the country with the lowest obstetric care facility densities in Tanzania Mainland with all the regions having lower obstetric care facility densities than the National average of 60 per 500,000 population [ 11 , 13 , 14 ]. Accordingly, the National policy under the Sharpened One Plan (2014–2015) had a special focus to address the Geographical inequity for women and children from the two zones [ 5 , 9 ].…”