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Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

Staff experiences of providing maternity services in rural southern Tanzania – a focus on equipment, drug and supply issues

Authors: Suzanne Penfold, Donat Shamba, Claudia Hanson, Jennie Jaribu, Fatuma Manzi, Tanya Marchant, Marcel Tanner, Kate Ramsey, David Schellenberg, Joanna Armstrong Schellenberg

Published in: BMC Health Services Research | Issue 1/2013

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Abstract

Background

The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies.

Methods

Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items.

Results

The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result.

Conclusions

Inadequately stocked and equipped facilities compromise the health system’s ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions.
Literature
1.
go back to reference Campbell OM, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006, 368 (9543): 1284-1299. 10.1016/S0140-6736(06)69381-1.CrossRefPubMed Campbell OM, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006, 368 (9543): 1284-1299. 10.1016/S0140-6736(06)69381-1.CrossRefPubMed
2.
go back to reference Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D: Maternal health in poor countries: the broader context and a call for action. Lancet. 2006, 368 (9546): 1535-1541. 10.1016/S0140-6736(06)69384-7.CrossRefPubMed Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D: Maternal health in poor countries: the broader context and a call for action. Lancet. 2006, 368 (9546): 1535-1541. 10.1016/S0140-6736(06)69384-7.CrossRefPubMed
3.
go back to reference The World Health Report 2005: Make every mother and child count. 2005, Geneva: World Health Organization The World Health Report 2005: Make every mother and child count. 2005, Geneva: World Health Organization
5.
go back to reference Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010, 375: 1969-1987. 10.1016/S0140-6736(10)60549-1.CrossRefPubMed Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010, 375: 1969-1987. 10.1016/S0140-6736(10)60549-1.CrossRefPubMed
6.
go back to reference Making pregnancy safer: the critical role of the skilled attendant. 2004, Geneva: World Health Oganization Making pregnancy safer: the critical role of the skilled attendant. 2004, Geneva: World Health Oganization
7.
go back to reference English M, Ntoburi S, Wagai J, Mbindyo P, Opiyo N, Ayieko P, Opondo C, Migiro S, Wamae A, Irimu G: An intervention to improve paediatric and newborn care in Kenyan district hospitals: understanding the context. Implementation Science. 2009, 4: 42-10.1186/1748-5908-4-42.CrossRefPubMedPubMedCentral English M, Ntoburi S, Wagai J, Mbindyo P, Opiyo N, Ayieko P, Opondo C, Migiro S, Wamae A, Irimu G: An intervention to improve paediatric and newborn care in Kenyan district hospitals: understanding the context. Implementation Science. 2009, 4: 42-10.1186/1748-5908-4-42.CrossRefPubMedPubMedCentral
8.
go back to reference Opondo C, Ntoburi S, Wagai J, Wafula J, Wasunna A, Were F, Wamae A, Migiro S, Irimu G, English M: Are hospitals prepared to support newborn survival? - An evaluation of eight first-referral level hospitals in Kenya. Trop Med Int Health. 2009, 14 (10): 1165-1172. 10.1111/j.1365-3156.2009.02358.x.CrossRefPubMedPubMedCentral Opondo C, Ntoburi S, Wagai J, Wafula J, Wasunna A, Were F, Wamae A, Migiro S, Irimu G, English M: Are hospitals prepared to support newborn survival? - An evaluation of eight first-referral level hospitals in Kenya. Trop Med Int Health. 2009, 14 (10): 1165-1172. 10.1111/j.1365-3156.2009.02358.x.CrossRefPubMedPubMedCentral
9.
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
10.
go back to reference Systems Thinking for Health Systems Strengthening. Edited by: Savigny D De, Adam T. 2009, Geneva: World Health Organization Systems Thinking for Health Systems Strengthening. Edited by: Savigny D De, Adam T. 2009, Geneva: World Health Organization
11.
go back to reference Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Marchal B: Going to scale with professional skilled care. Lancet. 2006, 368 (9544): 1377-1386. 10.1016/S0140-6736(06)69382-3.CrossRefPubMed Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Marchal B: Going to scale with professional skilled care. Lancet. 2006, 368 (9544): 1377-1386. 10.1016/S0140-6736(06)69382-3.CrossRefPubMed
12.
go back to reference Dogba M, Fournier P: Human resources and the quality of emergency obstetric care in developing countries: a systematic review of the literature. Hum Resour Health. 2009, 7: 7-10.1186/1478-4491-7-7.CrossRefPubMedPubMedCentral Dogba M, Fournier P: Human resources and the quality of emergency obstetric care in developing countries: a systematic review of the literature. Hum Resour Health. 2009, 7: 7-10.1186/1478-4491-7-7.CrossRefPubMedPubMedCentral
13.
go back to reference Armstrong Schellenberg J, Mrisho M, Manzi F, Shirimo K, Mbuya C, Mushi AK, Ketende SC, Alonso PL, Mshinda H, Tanner M: Health and survival of young children in Southern Tanzania. BMC Public Health. 2008, 8 (194): 10.1186/1471-2458-8-194. Armstrong Schellenberg J, Mrisho M, Manzi F, Shirimo K, Mbuya C, Mushi AK, Ketende SC, Alonso PL, Mshinda H, Tanner M: Health and survival of young children in Southern Tanzania. BMC Public Health. 2008, 8 (194): 10.1186/1471-2458-8-194.
14.
go back to reference Manji K: Situation analysis of newborn health in Tanzania: current situation, existing plans and strategic next steps for newborn health. 2009, Dar es Salaam: Ministry of Health and Social Welfare, Save the Children Manji K: Situation analysis of newborn health in Tanzania: current situation, existing plans and strategic next steps for newborn health. 2009, Dar es Salaam: Ministry of Health and Social Welfare, Save the Children
15.
go back to reference Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med. 1994, 38 (8): 1091-1110. 10.1016/0277-9536(94)90226-7.CrossRefPubMed Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med. 1994, 38 (8): 1091-1110. 10.1016/0277-9536(94)90226-7.CrossRefPubMed
16.
go back to reference Cham M, Sundby J, Vangen 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, Sundby J, Vangen 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
17.
go back to reference Sarker M, Schmid G, Larsson E, Kirenga S, De Allegri M, Neuhann F, Mbunda T, Lekule I, Muller O: Quality of antenatal care in rural southern Tanzania: a reality check. BMC Research Notes. 2010, 3: 209-10.1186/1756-0500-3-209.CrossRefPubMedPubMedCentral Sarker M, Schmid G, Larsson E, Kirenga S, De Allegri M, Neuhann F, Mbunda T, Lekule I, Muller O: Quality of antenatal care in rural southern Tanzania: a reality check. BMC Research Notes. 2010, 3: 209-10.1186/1756-0500-3-209.CrossRefPubMedPubMedCentral
18.
go back to reference Manongi RN, Marchant TC, Bygbjerg IC: Improving motivation among primary health care workers in Tanzania: a health worker perspective. Hum Resour Health. 2006, 4: 6-10.1186/1478-4491-4-6.CrossRefPubMedPubMedCentral Manongi RN, Marchant TC, Bygbjerg IC: Improving motivation among primary health care workers in Tanzania: a health worker perspective. Hum Resour Health. 2006, 4: 6-10.1186/1478-4491-4-6.CrossRefPubMedPubMedCentral
19.
go back to reference Tanzania Service Provision Assessment Survey 2006. 2007, Dar es Salaam: National Bureau of Statistics and Macro International Inc Tanzania Service Provision Assessment Survey 2006. 2007, Dar es Salaam: National Bureau of Statistics and Macro International Inc
20.
go back to reference Health Sector Reform Plan of Action 1999–2002. 1998, Dar es Salaam, Tanzania: Ministry of Health and Social Welfare Health Sector Reform Plan of Action 1999–2002. 1998, Dar es Salaam, Tanzania: Ministry of Health and Social Welfare
22.
go back to reference Tanzania Demographic and Health Survey 2010. 2011, Dar es Salaam, Tanzania: National Bureau of Statistics and ICF Macro, USA Tanzania Demographic and Health Survey 2010. 2011, Dar es Salaam, Tanzania: National Bureau of Statistics and ICF Macro, USA
23.
go back to reference Poverty and human development report. 2005, Dar es Salaam: Group TRaAW Poverty and human development report. 2005, Dar es Salaam: Group TRaAW
24.
go back to reference In-depth assessment of the medicines supply system in Tanzania. 2008, Dar es Salaam, Tanzania: Ministry of Health and Social Welfare In-depth assessment of the medicines supply system in Tanzania. 2008, Dar es Salaam, Tanzania: Ministry of Health and Social Welfare
25.
go back to reference Riwa P, Kihinga C, Mlay A, van Beekhuizen H, Simbaklia C: Assessment of the quality of reproductive health sevices in Lindi Region in 1999 and 2007. Final report. 2007, TGPSH Riwa P, Kihinga C, Mlay A, van Beekhuizen H, Simbaklia C: Assessment of the quality of reproductive health sevices in Lindi Region in 1999 and 2007. Final report. 2007, TGPSH
26.
go back to reference Monitoring Emergency Obstetric Care: A Handbook. 2009, Geneva: World Health Organization Monitoring Emergency Obstetric Care: A Handbook. 2009, Geneva: World Health Organization
27.
go back to reference Hunger C, Kulker R, Kitundu H, Massawe S, Jahn A: Assessing unmet obstetric need in Mtwara Region, Tanzania. Trop Med Int Health. 2007, 12 (10): 1239-1247. 10.1111/j.1365-3156.2007.01909.x.CrossRefPubMed Hunger C, Kulker R, Kitundu H, Massawe S, Jahn A: Assessing unmet obstetric need in Mtwara Region, Tanzania. Trop Med Int Health. 2007, 12 (10): 1239-1247. 10.1111/j.1365-3156.2007.01909.x.CrossRefPubMed
28.
go back to reference Penfold S, Hill Z, Mrisho M, Manzi F, Tanner M, Mshinda H, Schellenberg D, Armstrong Schellenberg JR: A large cross-sectional community-based study of newborn care practices in southern Tanzania. PLoS One. 2010, 5 (12): e15593-10.1371/journal.pone.0015593.CrossRefPubMedPubMedCentral Penfold S, Hill Z, Mrisho M, Manzi F, Tanner M, Mshinda H, Schellenberg D, Armstrong Schellenberg JR: A large cross-sectional community-based study of newborn care practices in southern Tanzania. PLoS One. 2010, 5 (12): e15593-10.1371/journal.pone.0015593.CrossRefPubMedPubMedCentral
29.
go back to reference Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D: Understanding home-based neonatal care practice in rural southern Tanzania. Trans R Soc Trop Med Hyg. 2008, 102 (7): 669-678. 10.1016/j.trstmh.2008.04.029.CrossRefPubMed Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D: Understanding home-based neonatal care practice in rural southern Tanzania. Trans R Soc Trop Med Hyg. 2008, 102 (7): 669-678. 10.1016/j.trstmh.2008.04.029.CrossRefPubMed
30.
go back to reference Tanzania HIV/AIDS and Malaria Indicator Survey 2007–08. 2008, Dar es Salaam: Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and Macro International Inc Tanzania HIV/AIDS and Malaria Indicator Survey 2007–08. 2008, Dar es Salaam: Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and Macro International Inc
31.
go back to reference Safe motherhood needs assessment. 2001, Geneva: World Health Organization Safe motherhood needs assessment. 2001, Geneva: World Health Organization
32.
go back to reference Dawson S, Manderson L, Tallo V: A manual for the Use of Focus Groups. 1993, Boston, MA: International Nutrition Foundation for Developing Countries (INFDC) Dawson S, Manderson L, Tallo V: A manual for the Use of Focus Groups. 1993, Boston, MA: International Nutrition Foundation for Developing Countries (INFDC)
33.
go back to reference Halcomb EJ, Davidson PM: Is verbatim transcription of interview data always necessary?. Appl Nurs Res. 2006, 19 (1): 38-42. 10.1016/j.apnr.2005.06.001.CrossRefPubMed Halcomb EJ, Davidson PM: Is verbatim transcription of interview data always necessary?. Appl Nurs Res. 2006, 19 (1): 38-42. 10.1016/j.apnr.2005.06.001.CrossRefPubMed
34.
go back to reference Glaser B, Strauss A: Discovery of substantive theory: a basic strategy underlying qualitative research. Am Behav Sci. 1965, 8 (5): 5-12.CrossRef Glaser B, Strauss A: Discovery of substantive theory: a basic strategy underlying qualitative research. Am Behav Sci. 1965, 8 (5): 5-12.CrossRef
35.
go back to reference Corbin J, Strauss A: Grounded theory research: procedures, canons and evaluative criteria. Zeitschrift für Soziologie. 1990, 19 (6): 418-427.CrossRef Corbin J, Strauss A: Grounded theory research: procedures, canons and evaluative criteria. Zeitschrift für Soziologie. 1990, 19 (6): 418-427.CrossRef
36.
go back to reference Strauss A, Corbin J: Grounded theory methodology: an overview. Handbook of qualitative research. Edited by: Denzin N, Lincoln Y. 1994, Thousand Oaks, CA: Sage, 273-285. Strauss A, Corbin J: Grounded theory methodology: an overview. Handbook of qualitative research. Edited by: Denzin N, Lincoln Y. 1994, Thousand Oaks, CA: Sage, 273-285.
37.
go back to reference Price catalogue of essential medicines, hospital supplies and lab reagents -. 2008, Dar es Salaam: Medical Stores Department, 2008–2009, /9 Price catalogue of essential medicines, hospital supplies and lab reagents -. 2008, Dar es Salaam: Medical Stores Department, 2008–2009, /9
38.
go back to reference Bradley S, McAuliffe E: Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health. 2009, 7: 14-10.1186/1478-4491-7-14.CrossRefPubMedPubMedCentral Bradley S, McAuliffe E: Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health. 2009, 7: 14-10.1186/1478-4491-7-14.CrossRefPubMedPubMedCentral
39.
go back to reference Pearson L, Shoo R: Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet. 2005, 88 (2): 208-215. 10.1016/j.ijgo.2004.09.027.CrossRefPubMed Pearson L, Shoo R: Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet. 2005, 88 (2): 208-215. 10.1016/j.ijgo.2004.09.027.CrossRefPubMed
40.
go back to reference The United Republic of Tanzania Drug Tracking Study Final Report. 2007, Søborg: Euro Health Group The United Republic of Tanzania Drug Tracking Study Final Report. 2007, Søborg: Euro Health Group
41.
go back to reference MSD stakeholders meeting. 2011, Mtwara: VETA MSD stakeholders meeting. 2011, Mtwara: VETA
42.
go back to reference Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE: Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007, 370 (9595): 1358-1369. 10.1016/S0140-6736(07)61578-5.CrossRefPubMed Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE: Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007, 370 (9595): 1358-1369. 10.1016/S0140-6736(07)61578-5.CrossRefPubMed
Metadata
Title
Staff experiences of providing maternity services in rural southern Tanzania – a focus on equipment, drug and supply issues
Authors
Suzanne Penfold
Donat Shamba
Claudia Hanson
Jennie Jaribu
Fatuma Manzi
Tanya Marchant
Marcel Tanner
Kate Ramsey
David Schellenberg
Joanna Armstrong Schellenberg
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-61

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