Subnational variation for care at birth in Tanzania: is this explained by place, people, money or drugs?

BMC Public Health

Research

Melisa Martínez-Álvarez¹  Josephine Borghi¹  Neha S. Singh¹  Joy E. Lawn¹  Corinne E. Armstrong²  Hoviyeh Afnan-Holmes³  Corrine W. Ruktanochai⁴  Chris Grundy⁵  Zoe Matthews⁶  Moke Magoma⁷  Gemini Mtei⁸  Georgina Msemo⁹  Theopista John^1,10 

[1] Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;Evidence for Action, Dar es Salaam, Tanzania;Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;Independent consultant, London, UK;Department of Geography & Environment, University of Southampton, Highfield, SO17 1BJ, Southampton, UK;Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Highfield, Southampton, UK;Evidence for Action, Dar es Salaam, Tanzania;Ifakara Health Institute, Dar es Salaam, Tanzania;Ministry of Health and Social Welfare, Dar es Salaam, Tanzania;World Health Organization, PO Box 9292, 1 Luthuli Street, Dar es Salaam, Tanzania;

关键词: Health systems;    Health financing;    Health workforce;    Childbirth;    Quality of care;    Newborn health;    Maternal health;    Tanzania;   

DOI  :  10.1186/s12889-016-3404-3

来源: Springer

【 摘 要 】

BackgroundTanzania achieved the Millennium Development Goal for child survival, yet made insufficient progress for maternal and neonatal survival and stillbirths, due to low coverage and quality of services for care at birth, with rural women left behind. Our study aimed to evaluate Tanzania’s subnational (regional-level) variations for rural care at birth outcomes, i.e., rural women giving birth in a facility and by Caesarean section (C-section), and associations with health systems inputs (financing, health workforce, facilities, and commodities), outputs (readiness and quality of care) and context (education and GDP).MethodsWe undertook correlation analyses of subnational-level associations between health system inputs, outputs, context, and rural care at birth outcomes; and constructed implementation readiness barometers using benchmarks for each health system input indicator. We used geographical information system (GIS) mapping to visualise subnational variations in care at birth for rural women, with a focus on service availability and readiness, and collected qualitative data to investigate financial flows from national to council level to understand variation in financing inputs.ResultsWe found wide subnational variation for rural care at birth outcomes, health systems inputs, and contextual indicators. There was a positive association between rural women giving birth in a facility and by C-section; maternal education; workforce and facility density; and quality of care. There was a negative association between these outcomes and proportion of all births to rural women, total fertility rate, and availability of essential commodities at facilities. Per capita recurrent expenditure was positively associated with facility births (correlation coefficient = 0.43; p = 0.05) but not with C-section. Qualitative results showed that the health financing system is complex and insufficient for providing care at birth services. Bottlenecks for care at birth included low density of health workers, poor availability of essential commodities, and low health financing in Lake and Western Zones.ConclusionsNo region meets the benchmarks for the four health systems building blocks including health finance, health workforce, health facilities, and commodities. Strategies for addressing health system inequities, including overall increases in health expenditure, are needed in rural populations and areas of highest unmet need for family planning to improve coverage of care at birth for rural women in Tanzania.

【 授权许可】

CC BY   
© The Author(s). 2016