Health System Support for Childbirth care in Southern Tanzania: Results from a Health Facility Census.

Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth offered at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2--3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constraints the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive "skilled attendance" and adequate care for common obstetric complications such as post-partum haemorrhage

Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

BACKGROUND: The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. METHODS: Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. RESULTS: The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". CONCLUSIONS: Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture

Glossary of collective bargaining terms

published or submitted for publicatio

Official roster of officers and employees in the civil service of the Philippine Islands.

1902 has imprint: Washington. Government printing office, 1902.Mode of access: Internet.Compiled by the Civil service board, 1902-05; by the Bureau of Civil service, 1906-

Reglamento del servicio civil. : Preparadô y aprobado por la Junta del servicio civil de Filipinas.

cover-titleMode of access: Internet

Annual report of the Philippine Bureau of Civil Service for the year ended ...

1905/06 includes also "Appendix...containing laws relating to the Philippine civil service, civil service rules, examination repuirements...opinions of the attorney-general, resolutions of the Philippine commission, statistics of examinations and appointments. Bureau of insular affairs, War Dept. Washington, 1907."Published: Manila, Bureau of Printing, 1908-Title varies slightly.None published 1931-1934; numbering restarted with no.1 (1935/1936), which covers Nov. 15, 1935-Dec. 31, 1936.First report covers period from Sept. 26 to Dec. 31, 1900.Report year irregular.1905/06 includes also "Appendix...containing laws relating to the Philippine civil service, civil service rules, examination repuirements...opinions of the attorney-general, resolutions of the Philippine commission, statistics of examinations and appointments. Bureau of insular affairs, War Dept. Washington, 1907."Mode of access: Internet.Issued by: Bureau of Insular Affairs, War Department, 1906-.Found also in the annual reports of the Philippine commission, 1901-08

Introduction to supervision; a basic course for the government supervisor. Guide for instructors.

Accompanied by "Participant print-outs for use with course guide for instructors. (1 v.) Published: Washington, U.S. Civil Service Commission, Bureau of Training, General Management Training Center; for sale by the Supt.of Docs., U.S. Govt. Print. Off., 1970.Mode of access: Internet

Interagency training programs.

Description based on: Fall 1959.Some years have also supplementary issues.Mode of access: Internet.Issued by: 1959-spring 1960, Operations Improvement Division, Bureau of Departmental Operations; fall 1960-1967/1968, Office of Career Development; 1968/1969-1970/1971, Bureau of Training.Continued by: United States Civil Service Commission. Bureau of Training. Interagency training programs catalog.Updated monthly by the U.S. Civil Service Commission's Monthly calendar

Monthly release.

Mode of access: Internet.Supersedes U.S. Civil Service Commission. Federal employment statistics bulletin and U.S. Civil Service Commission. Monthly report of Federal employment