Juma Damas, Stordal Ketil, Kamala Benjamin, Bishanga Dunstan R, Kalolo Albino, Moshiro Robert, Kvaløy Jan Terje, Manongi Rachel
Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania.
Manyara Regional Secretariat, Manyara, Tanzania.
BMC Health Serv Res. 2024 Jul 31;24(1):870. doi: 10.1186/s12913-024-11317-0.
Despite the global progress in bringing health services closer to the population, mothers and their newborns still receive substandard care leading to morbidity and mortality. Health facilities' capacity to deliver the service is a prerequisite for quality health care. This study aimed to assess health facilities' readiness to provide comprehensive emergency obstetric and newborn care (CEmONC), comprising of blood transfusion, caesarean section and basic services, and hence to inform improvement in the quality of care interventions in Tanzania.
A cross-sectional assessment of 30 CEmONC health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out between December 2020 and January 2021. We adapted the World Health Organization's Service Availability and Readiness Assessment tool to assess amenities, equipment, trained staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher's exact test; for readiness scores, differences were tested by a linear mixed model analysis, taking into account dependencies within the regions. We used p < 0.05 as our level of significance.
The overall readiness to provide CEmONC was 69.0% and significantly higher for regional hospitals followed by district hospitals. Average readiness was 78.9% for basic amenities, 76.7% for medical equipment, 76.0% for diagnosis and treatment commodities, 63.6% for staffing and 50.0% for guidelines. There was a variation in the availability of items at the individual health facility level and across levels of facilities. We found a significant difference in the availability of basic amenities, equipment, staffing, and guidelines between regional, and district hospitals and health centres (p = 0.05). Regional hospitals had significantly higher scores of medical equipment than district hospitals and health centers (p = 0.02). There was no significant difference in the availability of commodities for diagnosis and treatment between different facility levels.
Facilities' readiness was inadequate and varied across different levels of the facility. There is room to improve the facilities' readiness to deliver quality maternal and newborn care. The responsible authorities should take immediate actions to address the observed deficiencies while carefully choosing the most effective and feasible interventions and monitoring progress in readiness.
尽管在全球范围内，使卫生服务更贴近民众方面取得了进展，但母亲及其新生儿仍接受不合格的护理，导致发病和死亡。卫生设施提供服务的能力是优质医疗保健的先决条件。本研究旨在评估卫生设施提供包括输血、剖宫产和基本服务在内的全面紧急产科和新生儿护理（CEmONC）的准备情况，从而为坦桑尼亚护理干预质量的改善提供依据。
2020年12月至2021年1月期间，对坦桑尼亚五个地区实施“安全分娩护理包”的30家CEmONC卫生设施进行了横断面评估。我们采用了世界卫生组织的服务可用性和准备情况评估工具，以评估设施、设备、训练有素的工作人员、指南、药品和诊断设施。计算每个类别的综合准备得分，并在卫生设施层面比较结果。对于分类变量，我们通过Fisher精确检验来检验差异；对于准备得分，差异通过线性混合模型分析进行检验，同时考虑各地区内部的相关性。我们将p < 0.05作为显著性水平。
提供CEmONC的总体准备情况为69.0%，地区医院的准备情况显著高于区医院，其次是区医院。基本设施的平均准备情况为78.9%，医疗设备为76.7%，诊断和治疗用品为76.0%，人员配备为63.6%，指南为50.0%。在各个卫生设施层面以及不同级别的设施之间，物品的可用性存在差异。我们发现地区医院、区医院和卫生中心在基本设施、设备、人员配备和指南的可用性方面存在显著差异（p = 0.05）。地区医院的医疗设备得分显著高于区医院和卫生中心（p = 0.02）。不同级别设施之间诊断和治疗用品的可用性没有显著差异。
设施的准备情况不足，且在不同级别的设施中存在差异。在提高设施提供优质孕产妇和新生儿护理的准备情况方面仍有改进空间。相关当局应立即采取行动，解决观察到的不足之处，同时谨慎选择最有效和可行的干预措施，并监测准备情况的进展。
