Solnes Miltenburg Andrea, Kiritta Richard Forget, Bishanga Thabea Benedicto, van Roosmalen Jos, Stekelenburg Jelle
Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway.
Women Centered Care Project, a project of the African Woman Foundation, Magu, Mwanza Region, Tanzania.
BMC Pregnancy Childbirth. 2017 Mar 20;17(1):92. doi: 10.1186/s12884-017-1282-z.
Regular monitoring and assessment of performance indicators for emergency obstetric and newborn care can help to identify priorities to improve health services for women and newborns. The aim of this study was to perform a district wide assessment of emergency obstetric and newborn care performance and identify ways for improvement.
Facility assessment of 13 dispensaries, four health centers and one district hospital in a rural district in Tanzania was performed in two data collection periods in 2014. Assessment included a facility walk-through to observe facility infrastructure and interviews with facility in-charges to assess available services, staff and supplies. In addition facility statistics were collected for the year 2013. Results were discussed with district representatives.
Approximately 65% of expected births took place in health facilities and 22% of women with complications were treated in facilities expected to provide emergency care. None of the facilities was, however, able to perform at the expected level for emergency obstetric and newborn care since not all required signal functions could be provided. Inadequate availability of essential drugs such as uterotonics, antibiotics and anticonvulsants as well as lack of ability to perform vacuum extraction and blood transfusion limited performance.
Performance of emergency obstetric and newborn care in Magu District was not in accordance with expected guidelines and highly influenced by lack of available resources and an insufficiently functioning health care system. Improving assessment approaches, to look beyond the signal functions, can capture weaknesses in the system and will help to understand poor performance and identify locally applicable ways for improvement.
定期监测和评估产科急诊及新生儿护理的绩效指标，有助于确定改善妇女和新生儿卫生服务的重点。本研究的目的是对产科急诊及新生儿护理绩效进行全区评估，并确定改进方法。
2014年分两个数据收集阶段，对坦桑尼亚一个农村地区的13家诊所、4家卫生中心和1家区级医院进行了机构评估。评估包括实地走访机构以观察基础设施，并与机构负责人访谈以评估现有服务、人员和物资。此外，收集了2013年的机构统计数据。评估结果与地区代表进行了讨论。
约65%的预期分娩在医疗机构进行，22%有并发症的妇女在预期提供急诊护理的机构接受治疗。然而，由于并非所有必需的信号功能都能提供，没有一家机构能够达到产科急诊及新生儿护理的预期水平。宫缩剂、抗生素和抗惊厥药等基本药物供应不足，以及缺乏进行真空吸引和输血的能力，限制了服务绩效。
马古区产科急诊及新生儿护理的绩效不符合预期指南，且受到可用资源短缺和医疗系统功能不足的严重影响。改进评估方法，超越信号功能进行考察，能够发现系统中的薄弱环节，有助于理解服务绩效不佳的情况，并确定适用于当地的改进方法。
