The structural quality of maternal health services in primary health care facilities in Tanzania: Findings from a baseline study

Abstract

AbstractBackgroundStructural quality of maternal health services remains a key indicator of highly performing health care system. Evidence attest to the fact that introduction of the new interventions in the health care system does not necessarily lead into improvement of the target outcome, such as quality of health services delivered. This study aimed at assessing the structural quality of maternal health services prior to introduction of Direct Health Facility Financing (DHFF) program.MethodsThis was a cross-sectional study, conducted in 42 public primary health facilities between January and mid February 2018. Observational were used to collect the data from health facilities. The collected information was on privacy, hygiene and sanitation, obstetric emergences, sterilization, maternal death audit reviews and waste management. Collected data were analyzed by using SPSS.ResultsAll 42 (100%) primary health facilities that were assessed were public primary health facilities, of which 14 (33.3%) were health centers and 28 were dispensaries. The furthest primary health facilities from the district head office were 140 Kms and the nearest 2 Kms. Focusing on; - privacy, hygiene and sanitation, obstetric emergences, sterilization, maternal death audit reviews and waste management assessed eight areas of Structural qualities. Majority (68.9%) of Health Centers has less than 39 skilled staff while some of them they have up to 129 health service providers and majority (92.8%) of Dispensaries have less than 15 staff and some have 1 staff.By comparing Dispensary and Health center performances on structural quality indicated relatively low differences among the attributes assessed. Specifically, they did not show statistical significant differences except for obstetric emergencies (p < .005), sterilization (p=. 034) and overall structural quality (p=. 018). With regard to rural-urban performance on structural quality, there was no statistical significant difference on total performance. Similarly, there was no significant differences between rural and urban health facilities on other assessed attributes of structural quality (p >.05) except for sterilization in which urban facilities performed significantly higher than the rural facilities [M=41.2, SD=27.7, 61.3, SD=28.4, respectively (p= .028)]. On the other hand, marginal differences were observed on individual assessed attributes. For examples, rural facilities performed relatively higher than urban ones on privacy (41.2 and 32.0), maternal death reviews (31.4 and 30.7) and waste management (49.0 and 47.3) respectively.ConclusionGenerally facilities performed low on the structural quality indicators of maternal health services provision however; they had high performance on sterilization and emergence obstetric care.