Maternal and perinatal mortality remain a challenge in
resource-limited countries, particularly among the rural poor. To save lives at
birth health facility delivery is recommended. However, increasing coverage of
institutional deliveries may not translate into mortality reduction if shortage
of qualified staff and lack of enabling working conditions affect quality of
services. In Tanzania childbirth care is available in all facilities; yet
maternal and newborn mortality are high. The study aimed to assess in a high
facility density rural context whether a health system organization with fewer
delivery sites is feasible in terms of population access.
Data on health facilities’ location, staffing and delivery
caseload were examined in Ludewa and Iringa Districts, Southern Tanzania.
Geospatial raster and network analysis were performed to estimate access to
obstetric services in walking time. The present geographical accessibility was
compared to a theoretical scenario with a 40% reduction of delivery sites.
About half of first-line health facilities had insufficient
staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in
Ludewa District). Yearly delivery caseload at first-line health facilities was
low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and
Ludewa District respectively. Wide geographical overlaps of facility catchment
areas were observed. In Iringa 54% of the population was within 1-hour walking
distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the
percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites,
approximately 80% of population will still be within 2 hours’ walking time.
Our findings from spatial modelling in a high facility
density context indicate that reducing delivery sites by 40% will decrease
population access within 2 hours by 7%. Focused efforts on fewer delivery sites
might assist strengthening delivery services in resource-limited settings.
Below: Location map of Ludewa and Iringa Districts
Below: Catchment area estimated by raster analysis.
The areas around health facilities represent a 2 hours’ catchment divided in 20 minutes’ intervals. (A) Iringa District current scenario with all delivery sites; (B) Iringa District proposed scenario with reduced number of delivery sites; (C) Ludewa District current scenario with all delivery sites; (D) Ludewa District proposed scenario with reduced number of delivery sites. The grey shades delimit the areas that will loose accessibility within 2 hours by a 40% reduction of delivery sites.
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