Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural District of Tanzania

Authors: Dickson Ally Mkoka, Isabel Goicolea, Angwara Kiwara, Mughwira Mwangu, Anna-Karin Hurtig

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

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.
Literature
3.
go back to reference Ronsmans C, Kraham WJ: Maternal mortality; who, when, where and why. Lancet. 2006, 368 (9542): 1189-1200. 10.1016/S0140-6736(06)69380-X.CrossRefPubMed Ronsmans C, Kraham WJ: Maternal mortality; who, when, where and why. Lancet. 2006, 368 (9542): 1189-1200. 10.1016/S0140-6736(06)69380-X.CrossRefPubMed
4.
go back to reference Jamison DT, Feachem RG, Makgoba MW: Disease and Mortality in Sub-Saharan Africa. 2006, Washington (DC): World Bank, 2 Jamison DT, Feachem RG, Makgoba MW: Disease and Mortality in Sub-Saharan Africa. 2006, Washington (DC): World Bank, 2
5.
go back to reference Fournier P, Dumont A, Tourigny C, Dunkley G, Dramé S: Improved access to comprehensive emergency obstetric care and its Effect on institutional maternal mortality in rur al Mali. Bull World Health Organ. 2009, 87: 30-38. 10.2471/BLT.07.047076. d0i:10.2471/BLT.07.047078CrossRefPubMed Fournier P, Dumont A, Tourigny C, Dunkley G, Dramé S: Improved access to comprehensive emergency obstetric care and its Effect on institutional maternal mortality in rur al Mali. Bull World Health Organ. 2009, 87: 30-38. 10.2471/BLT.07.047076. d0i:10.2471/BLT.07.047078CrossRefPubMed
6.
go back to reference Cham M, Sunby J, Vangeri S: Maternal mortality in the Rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005, 2 (1): 3-10.1186/1742-4755-2-3.CrossRefPubMedPubMedCentral Cham M, Sunby J, Vangeri S: Maternal mortality in the Rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005, 2 (1): 3-10.1186/1742-4755-2-3.CrossRefPubMedPubMedCentral
7.
go back to reference World Health Organization: Mother-baby package: implementing safe motherhood in countries. 1994, Geneva: Maternal Health and Safe Motherhood Programme, Division of Family Health, WHO, 88- World Health Organization: Mother-baby package: implementing safe motherhood in countries. 1994, Geneva: Maternal Health and Safe Motherhood Programme, Division of Family Health, WHO, 88-
10.
go back to reference Olsen OE, Ndeki S, Norheim OF: Human resources for emergency obstetric care in Northern Tanzania; distribution of quality or quality?. Hum Resour Health. 2005, 3: 5-10.1186/1478-4491-3-5.CrossRefPubMedPubMedCentral Olsen OE, Ndeki S, Norheim OF: Human resources for emergency obstetric care in Northern Tanzania; distribution of quality or quality?. Hum Resour Health. 2005, 3: 5-10.1186/1478-4491-3-5.CrossRefPubMedPubMedCentral
11.
go back to reference Pembe AB, Carlstedt A, Urassa DP, Lindmark G, Lennarth N, Darj E: Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania. BMC Health Serv Res. 2010, 10: 326-10.1186/1472-6963-10-326.CrossRefPubMedPubMedCentral Pembe AB, Carlstedt A, Urassa DP, Lindmark G, Lennarth N, Darj E: Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania. BMC Health Serv Res. 2010, 10: 326-10.1186/1472-6963-10-326.CrossRefPubMedPubMedCentral
12.
go back to reference Spangler SA: Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities. Reprod Health Matters. 2012, 20 (39): 133-141. 10.1016/S0968-8080(12)39603-4.CrossRefPubMed Spangler SA: Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities. Reprod Health Matters. 2012, 20 (39): 133-141. 10.1016/S0968-8080(12)39603-4.CrossRefPubMed
14.
go back to reference Echoka E, Kombe Y, Dubourg D, Makokha A, Olsen BE, Mwangi M, Byskov J, Olsen QE, Mutisya R: Existence and functionality of emergency obstetric care services at district level in Kenya: theoretical coverage versus reality. BMC Health Serv Res. 2013, 13: 113-10.1186/1472-6963-13-113.CrossRefPubMedPubMedCentral Echoka E, Kombe Y, Dubourg D, Makokha A, Olsen BE, Mwangi M, Byskov J, Olsen QE, Mutisya R: Existence and functionality of emergency obstetric care services at district level in Kenya: theoretical coverage versus reality. BMC Health Serv Res. 2013, 13: 113-10.1186/1472-6963-13-113.CrossRefPubMedPubMedCentral
15.
go back to reference Prytherch H, Massawe S, Kuelker R, Hunger C, Mtatifikolo F, Jahn A: The unmet need for emergency obstetric care in Tanga Region, Tanzania. BMC Pregnancy & Childbirth. 2007, 7: 16-10.1186/1471-2393-7-16.CrossRef Prytherch H, Massawe S, Kuelker R, Hunger C, Mtatifikolo F, Jahn A: The unmet need for emergency obstetric care in Tanga Region, Tanzania. BMC Pregnancy & Childbirth. 2007, 7: 16-10.1186/1471-2393-7-16.CrossRef
17.
go back to reference Tumwine Y, Kutyabami P, Odor AR, Kalyango JN: Availability and expiry of essential medicines and supplies during the “Pull” and “Push” Drug acquisition systems in rural Ugandan Hospital. Trop J Pharmaceut Res. 2010, 9 (6): 557-564. Tumwine Y, Kutyabami P, Odor AR, Kalyango JN: Availability and expiry of essential medicines and supplies during the “Pull” and “Push” Drug acquisition systems in rural Ugandan Hospital. Trop J Pharmaceut Res. 2010, 9 (6): 557-564.
18.
go back to reference Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Moreland S, Gikaara N, Atieno M, Kataike J, Nsubuga C, Munene G, Banga G, Higginson IJ: Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross section survey with onsite verification. Palliat Med. 2013 Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Moreland S, Gikaara N, Atieno M, Kataike J, Nsubuga C, Munene G, Banga G, Higginson IJ: Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross section survey with onsite verification. Palliat Med. 2013
19.
go back to reference Penfold S, Shamba D, Hanson C, Jaribu J, Manzi F, Marchant T, Ramsey K, Schellenberg D, Schellenberg JA: Staff experiences of providing maternity services in rural southern Tanzania- a focus on equipment, drug and supply issues. BMC Health Serv Res. 2013, 13: 61-10.1186/1472-6963-13-61.CrossRefPubMedPubMedCentral Penfold S, Shamba D, Hanson C, Jaribu J, Manzi F, Marchant T, Ramsey K, Schellenberg D, Schellenberg JA: Staff experiences of providing maternity services in rural southern Tanzania- a focus on equipment, drug and supply issues. BMC Health Serv Res. 2013, 13: 61-10.1186/1472-6963-13-61.CrossRefPubMedPubMedCentral
20.
go back to reference Ziraba AK, Mills S, Madise N, Saliku T, Fotso J: The state of emergency obstetric care services in Nairobi informal settlements and environs. Results from a maternity health facility survey. BMC Health Serv Res. 2009, 9: 46-10.1186/1472-6963-9-46.CrossRefPubMedPubMedCentral Ziraba AK, Mills S, Madise N, Saliku T, Fotso J: The state of emergency obstetric care services in Nairobi informal settlements and environs. Results from a maternity health facility survey. BMC Health Serv Res. 2009, 9: 46-10.1186/1472-6963-9-46.CrossRefPubMedPubMedCentral
21.
go back to reference Pearson L, Shoo R: Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan and Uganda. Int J Gynecol Obstet. 2005, 88: 208-215. 10.1016/j.ijgo.2004.09.027.CrossRef Pearson L, Shoo R: Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan and Uganda. Int J Gynecol Obstet. 2005, 88: 208-215. 10.1016/j.ijgo.2004.09.027.CrossRef
26.
go back to reference Tanzania: Integrated logistics system pilot test evaluation. Using the logistics indicator assessment tool. USAID. 2005 Tanzania: Integrated logistics system pilot test evaluation. Using the logistics indicator assessment tool. USAID. 2005
31.
go back to reference Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol. 2006, 3 (2): 77-10. 10.1191/1478088706qp063oa.CrossRef Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol. 2006, 3 (2): 77-10. 10.1191/1478088706qp063oa.CrossRef
33.
go back to reference van Olmen J, Criel B, van Damme W: Marchal B, van Belle S, van Dormael M, Hoeree T, Pirard M, Kegels G: Analysing Health Systems To Make Them Stronger. Studies in Health Services Organization & Policy. 2010, Antwerp, Belgium: ITGPress, Nationalestraat 155, B-2000 van Olmen J, Criel B, van Damme W: Marchal B, van Belle S, van Dormael M, Hoeree T, Pirard M, Kegels G: Analysing Health Systems To Make Them Stronger. Studies in Health Services Organization & Policy. 2010, Antwerp, Belgium: ITGPress, Nationalestraat 155, B-2000
34.
go back to reference Randive B, Diwan V, Costa AD: Indian’s conditional cash transfer programme (The JYS) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality?. PLOS ONE. 2013, 8 (6): e67452-10.1371/journal.pone.0067452.CrossRefPubMedPubMedCentral Randive B, Diwan V, Costa AD: Indian’s conditional cash transfer programme (The JYS) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality?. PLOS ONE. 2013, 8 (6): e67452-10.1371/journal.pone.0067452.CrossRefPubMedPubMedCentral
35.
go back to reference Safe Motherhood Inter-Agency Group: Technical Consultation “Ensure skilled attendance at delivery. (2000a) (2000), Geneva: New York: SMIAG/FCI; 2000 Safe Motherhood Inter-Agency Group: Technical Consultation “Ensure skilled attendance at delivery. (2000a) (2000), Geneva: New York: SMIAG/FCI; 2000
36.
go back to reference Emergency Obstetric Care: Quick Reference Guide for Frontline Providers. Emergency. Obstetric Care. United States Agency for. International Development. [pdf.usaid.gov/pdf_docs/PNACY580.pdf] Emergency Obstetric Care: Quick Reference Guide for Frontline Providers. Emergency. Obstetric Care. United States Agency for. International Development. [pdf.usaid.gov/pdf_docs/PNACY580.pdf]
37.
go back to reference MOHWS: Emergency Obstetric Care Job Aid. 2008, Dare-es-Salaam – Tanzania: Ministry of Health and Social Welfare MOHWS: Emergency Obstetric Care Job Aid. 2008, Dare-es-Salaam – Tanzania: Ministry of Health and Social Welfare
39.
go back to reference Mselle LT, Moland KM, Mvungi A, Olsen BE, Kohi TW: Why give birth in health facility?: Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Serv Res. 2013, 13: 174-10.1186/1472-6963-13-174.CrossRefPubMedPubMedCentral Mselle LT, Moland KM, Mvungi A, Olsen BE, Kohi TW: Why give birth in health facility?: Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Serv Res. 2013, 13: 174-10.1186/1472-6963-13-174.CrossRefPubMedPubMedCentral
40.
go back to reference Olsen OE, Ndeki S, Norheim OF: Availability, distribution and use of emergency obstetric care in northern Tanzania. Health Policy Plan. 2005, 20 (3): 167-175. 10.1093/heapol/czi022.CrossRefPubMed Olsen OE, Ndeki S, Norheim OF: Availability, distribution and use of emergency obstetric care in northern Tanzania. Health Policy Plan. 2005, 20 (3): 167-175. 10.1093/heapol/czi022.CrossRefPubMed
44.
go back to reference Msuya JM, Juting JP, Astaw A: Impacts of community health insurance schemes on health care povision in Rural Tanzania. 2004 Msuya JM, Juting JP, Astaw A: Impacts of community health insurance schemes on health care povision in Rural Tanzania. 2004
45.
go back to reference Kamuzora P, Gilson L: Factors influencing implementation of the Community Health Fund in Tanzania. Health Policy Plan. 2007, 22: 95-102. 10.1093/heapol/czm001. doi:10.1093/heapol/czm001CrossRefPubMed Kamuzora P, Gilson L: Factors influencing implementation of the Community Health Fund in Tanzania. Health Policy Plan. 2007, 22: 95-102. 10.1093/heapol/czm001. doi:10.1093/heapol/czm001CrossRefPubMed
46.
go back to reference Mtei G, Mulligan JO: Community health funds in Tanzania. A Literature Review. 2007 Mtei G, Mulligan JO: Community health funds in Tanzania. A Literature Review. 2007
47.
go back to reference Chee G, Kimberly S, Kapinga A, Musau S: Assessment of the Community Health Fund in Hanang District, Tanzania. Technical Report No.15. 2002, Bethesda, MD: Partnerships for Health Reform (PHR), Abt Associates Inc Chee G, Kimberly S, Kapinga A, Musau S: Assessment of the Community Health Fund in Hanang District, Tanzania. Technical Report No.15. 2002, Bethesda, MD: Partnerships for Health Reform (PHR), Abt Associates Inc
48.
go back to reference Musau S: The Community Health Fund: Assessing implementation of new management procedures in Hanang District, Tanzania. Technical Report No.34. 2004, Bethesda, MD: Partnerships for Health Reform (PHR), Abt Associates Inc Musau S: The Community Health Fund: Assessing implementation of new management procedures in Hanang District, Tanzania. Technical Report No.34. 2004, Bethesda, MD: Partnerships for Health Reform (PHR), Abt Associates Inc
49.
go back to reference United Republic of Tanzania (URT): Assessment of Community Health Fund in Tanzania: factors affecting enrolment and coverage. 2003, Dar es Salaam: Ministry of Health United Republic of Tanzania (URT): Assessment of Community Health Fund in Tanzania: factors affecting enrolment and coverage. 2003, Dar es Salaam: Ministry of Health
50.
go back to reference Granehein UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24: 105-112. 10.1016/j.nedt.2003.10.001.CrossRef Granehein UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24: 105-112. 10.1016/j.nedt.2003.10.001.CrossRef
Metadata
Title
Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural District of Tanzania
Authors
Dickson Ally Mkoka
Isabel Goicolea
Angwara Kiwara
Mughwira Mwangu
Anna-Karin Hurtig
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-108

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue