Requirements and costs for scaling up comprehensive emergency obstetric and neonatal care in health centres in Tanzania

The objective of this study was to identify and determine the costs of essential components of a resource package and strategies for scaling up comprehensive emergency obstetric and neonatal care services in Tanzania. Essential components were identified through lessons learned during implementation of comprehensive emergency obstetric and neonatal care and regular discussions with key stakeholders. The related costs were collected from the health centres, Tanzania Medical Store Department and non-governmental organizations that had upgraded health centres for comprehensive emergency obstetric and neonatal care services provision. The results showed that the estimated costs of upgrading a health centre to provide comprehensive emergency obstetric and neonatal care services was $256,650 (USD) for infrastructure and equipment,$4,463 per person for upgrading skills in either in comprehensive emergency obstetric and neonatal care or anaesthesia for three months and $43,500 per year for medicines and supplies. The total cost for all components per health centre was estimated at$560,802. Scale up required many complementary strategies at all health system levels. Scale up of comprehensive emergency obstetric and neonatal care services in health ccentres in underserved areas is feasible and urgently needed in resource-limited countries.   L'objectif de cette étude était d'identifier et de déterminer les coûts des composants essentiels d'un ensemble de ressources et de stratégies pour étendre les services complets de soins obstétricaux et néonatals d'urgence en Tanzanie. Les éléments essentiels ont été identifiés grâce aux enseignements tirés lors de la mise en oeuvre de soins obstétricaux et néonatals d'urgence complets et de discussions régulières avec les principales parties prenantes. Les coûts correspondants ont été collectés auprès des centres de santé, du département de pharmacie de Tanzanie et d'organisations non gouvernementales qui avaient modernisé les centres de santé pour une prestation complète de services de soins obstétricaux et néonatals d'urgence. Les résultats ont montré que les coûts estimés de la modernisation d'un centre de santé pour fournir des services complets de soins obstétricaux et néonatals d'urgence étaient de 256 650 $(USD) pour l'infrastructure et l'équipement, 4 463$ par personne pour la mise à niveau des compétences en soins obstétricaux et néonatals d'urgence complets ou en anesthésie pour mois et 43 500 $par an pour les médicaments et les fournitures. Le coût total de toutes les composantes par centre de santé a été estimé à 560 802$. La mise à l'échelle a nécessité de nombreuses stratégies complémentaires à tous les niveaux du système de santé. L'extension des services complets de soins obstétricaux et néonatals d'urgence dans les centres de santé des zones mal desservies est faisable et urgente dans les pays à ressources limitées &nbsp

Improving access, quality and safety of caesarean section services in underserved rural Tanzania: The impact of knowledge translation strategies

This research was designed to study different approaches to improve access to, and quality of caesarean section services in underserved Tanzania and translate evidence into practice. In 2016, 42 associate clinicians from five health centers were trained in teams for three months in comprehensive emergency obstetric and neonatal care and anesthesia followed by post-training supportive supervision and mentorship. From 2016-2019, 2,179 caesarean sections were performed in the intervention and 969 in the control health centers. Catchment population-based caesarean section rates increased significantly in all five intervention health centers and were more than 10% in three facilities. The risk of a woman dying from complications of caesarean section in the intervention health centers was 2.3 per 1,000 caesarean sections (95% CI 0.7 - 5.3). This educational program was adopted by the government and can be used to meet the demand for caesarean section services in other underserved areas in Africa.   Cette recherche a été conçue pour étudier différentes approches pour améliorer l'accès et la qualité des services de césarienne en Tanzanie mal desservie et traduire les preuves en pratique. En 2016, 42 cliniciens associés de cinq centres de santé ont été formés en équipes pendant trois mois aux soins obstétricaux et néonatals d'urgence complets et à l'anesthésie suivis d'une supervision et d'un mentorat post-formation. De 2016 à 2019, 2 179 césariennes ont été réalisées dans les centres de santé d'intervention et 969 dans les centres de santé témoins. Les taux de césariennes dans la population desservie ont augmenté de manière significative dans les cinq centres de santé d'intervention et étaient supérieurs à 10 % dans trois établissements. Le risque qu'une femme meure des complications d'une césarienne dans les centres de santé d'intervention était de 2,3 pour 1 000 césariennes (IC à 95 % 0,7 - 5,3). Ce programme éducatif a été adopté par le gouvernement et peut être utilisé pour répondre à la demande de services de césarienne dans d'autres régions mal desservies d'Afriqu

Building leadership and managerial capacity for maternal and newborn health services

Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania. The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings. Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building. Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision.Global Afairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Abstracts of Tanzania Health Summit 2020

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future. Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)