Availability, distribution and use of emergency obstetric care in northern Tanzania
1 Centre for International Health, University of Bergen, Norway, 2 Centre for Educational Development and Health, Arusha (CEDHA), Tanzania and 3 Section for Medical Ethics and Philosophy of Science, Department of Public Health and Primary Care, University of Bergen, Norway
Correspondence: Øystein Evjen Olsen, P.B. 105297, Dar Es Salaam, Tanzania. Email: oystein.olsen{at}cih.uib.no
The objective of this study is to determine the availability, distribution and quality of facilities providing delivery services, as well as their use by pregnant women.
The study is a survey of all facilities providing delivery services (n=129) in six districts in northern Tanzania. The framework provided by the UNICEF/UNFPA/WHO (UN) Guidelines is applied. An attempt is made to answer the first three questions in this audit outline: are there enough emergency obstetric care (EmOC) facilities? Are they well distributed? And are enough women using them?
The results show that there is a very low availability of basic emergency obstetric care (BEmOC) units (1.6/500 000), and a relatively high availability of comprehensive emergency obstetric care (CEmOC) units (4.6/500 000), both with large urban/rural variation. The percentage of expected deliveries in EmOC facilities is 36%, compared with the UN Guidelines minimum accepted threshold of 15%. Nevertheless, the distribution shows a much higher utilization in urban districts compared with rural, indicating that mothers have to travel long distances to receive adequate services when in need of them. The paper also discusses the provisional context of the services in terms of level of facilities providing them and their public/private mix. Most facility deliveries are conducted at CEmOC facilities. Pregnant women tend to utilize the services of voluntary agencies to a greater degree than government services in rural areas, while the government services have a higher burden of the workload in urban areas. A majority (86%) of the deliveries occurring in voluntary agency facilities occur in a qualified EmOC facility.
Against a backdrop of a large availability of any facility regardless of their emergency obstetric care status (41.9/500 000), this paper argues that given the large number of potential BEmOC facilities, it seems more efficient to shift resources within the BEmOC level, compared with from CEmOC level down to BEmOC level, to improve access to quality services. There is a large potential for quality improvement, in particular at dispensary and health centre levels. We argue that the main barrier to access to quality care is not the mother's ignorance or their ability to get to a facility, but the actual quality of care meeting them at the facility.
Key Words: emergency obstetric care, quality control, resource allocation, quality improvement, poverty reduction strategies