Background
Aim
Tanzanian health system
Ordering and equipment maintenance systems
Study context
Methods
Study area
Study design
Data collection
Quantitative
Qualitative
Data processing and analysis
Quantitative
Qualitative
Approvals and permission
Results
Facility characteristics
Item | n (%) facilities where item present (and functioning, for equipment) | N (%) facilities where broken equipment present | |||
---|---|---|---|---|---|
Hospitals (N = 4)
|
Health centres (N = 15)
|
Dispensaries (N = 156)
|
Total (N = 175)
|
Total (N = 175)
| |
Basic equipment
| |||||
Examination couch | 4 (100) | 14 (93) | 143 (92) | 161 (92) | 2 (1) |
Storage area for drugs | 4 (100) | 15 (100) | 142 (91) | 161 (92) | 3 (2) |
Refrigerator (2–8 °C) | 2 (50) | 10 (63) | 90 (58) | 102 (28) | 49 (28) |
Hand washing facility | 4 (100) | 15 (100) | 130 (83) | 149 (85) | 4 (2) |
Telephone or transmitter | 3 (75) | 5 (33) | 12 (8) | 20 (11) | 16 (9) |
Electricity | 4 (100) | 15 (100) | 53 (34) | 72 (41) | 5 (3) |
Blood pressure machine | 3 (75) | 15 (100) | 89 (57) | 107 (61) | 36 (21) |
Adult weighing scale | 4 (100) | 15 (100) | 118 (76) | 137 (78) | 18 (10) |
Stethoscope | 4 (100) | 15 (100) | 131 (84) | 150 (86) | 11 (6) |
Means of sterilisation | 3 (75) | 15 (100) | 139 (89) | 157 (90) | 5 (3) |
Clinical thermometer | 4 (100) | 15 (100) | 139 (89) | 158 (90) | 2 (1) |
Scissors | 4 (100) | 14 (93) | 142 (91) | 160 (91) | 5 (3) |
Equipment for maternal care
| |||||
Fetoscope | 4 (100) | 15 (100) | 149 (96) | 168 (96) | 2 (1) |
Infant weighing scale | 4 (100) | 15 (100) | 103 (66) | 122 (70) | 22 (13) |
Transport for obstetric referral | 4 (100) | 8 (53) | 30 (19) | 42 (24) | 7 (4) |
Manual vacuum aspirator | 4 (100) | 7 (47) | 1 (1) | 12 (7)** | 1 (1) |
Speculum | 4 (100) | 15 (100) | 81 (52) | 100 (57) | 7 (4) |
Vacuum extractor | 2 (50) | 2 (13) | 1 (1) | 5 (3) | 0 (0) |
Needle holder | 4 (100) | 12 (80) | 96 (62) | 112 (64) | 1 (1) |
Adult ambu bag | 2 (50) | 2 (13) | 3 (2) | 7 (4)** | 3 (2) |
Newborn ambu bag | 4 (100) | 9 (60) | 38 (24) | 51 (29) | 2 (1) |
Suction machine + adult tubes | 0 (0) | 1 (7) | 0 (0) | 1 (1) | 7 (4) |
Suction machine + children tubes | 2 (50) | 1 (7) | 5 (3) | 8 (5) | 0 (0) |
Supplies and drugs
| |||||
Examination gloves | 4 (100) | 14 (93) | 145 (93) | 163 (93) | |
Disposable syringes and needles – adult | 4 (100) | 10 (63) | 125 (80) | 139 (79) | |
Giving set – blood | 4 (100) | 1 (7) | 8 (5) | 13 (7) | |
Giving set – other fluids | 4 (100) | 15 (100) | 92 (59) | 111 (63) | |
Intravenous cannulae – size 16, 18 or 20 | 4 (100) | 12 (80) | 57 (37) | 73 (42) | |
Protective clothing for staff | 4 (100) | 14 (93) | 96 (62) | 115 (66) | |
Complete suture kits | 3 (75) | 8 (53) | 44 (28) | 55 (31) | |
Normal saline | 3 (75) | 9 (60) | 51 (33) | 63 (36) | |
Blank partograph | 4 (100) | 11 (73) | 106 (68) | 121 (69) | |
Cord ligatures | 4 (100) | 11 (73) | 122 (78) | 137 (78) | |
Disposable syringes and needles – neonate | 4 (100) | 10 (63) | 130 (83) | 144 (82) | |
Oxygen cylinder | 4 (100) | 4 (27) | 20 (13) | 28 (16) | |
Diazepam injection | 4 (100) | 14 (93) | 126 (81) | 144 (82) | |
Magnesium Sulphate injection | 3 (75) | 8 (53) | 80 (51) | 91 (52) | |
Hydralazine injection | 3 (75) | 0 (0) | 2 (1)** | 5 (3) | |
Misoprostol tablets (100 or 200 μg)* | 1 (25) | 5 (33) | 7 (4) | 13 (7) | |
Ergometrine injection | 1 (25) | 4 (27) | 58 (37) | 63 (55) | |
Oxytocin injection | 4 (100) | 5 (33) ** | 23 (15)** | 32 (18) | |
Any antibiotic injection | 4 (100) | 14 (93) | 127 (81) | 145 (83) | |
Ringer’s lactate | 4 (100) | 9 (60) | 55 (35) | 68 (39) | |
10% Dextrose | 3 (75) | 1 (7) | 2 (1) | 6 (3) | |
5% Dextrose | 3 (75) | 11 (73) | 41 (26) | 55 (31) |
n/N* (%)facilities stocking item where item has recorded stock out between July 1stand December 31st2008 | ||||
---|---|---|---|---|
Supply item or drug
|
Hospitals
|
Health centres
|
Dispensaries
|
Total
|
Examination gloves | 2/4 (50) | 6/15 (40) | 80/154 (52) | 88/173 (51) |
Giving set – blood | 1/4 (25) | 1/2 (50) | 15/19 (79) | 17/25 (68) |
Giving set – other fluids | 1/4 (25) | 6/15 (40) | 56/103 (54) | 63/122 (52) |
Intravenous cannulae – size 16, 18 or 20 | 1/4 (25) | 9/15 (60) | 49/78 (63) | 59/97 (61) |
Blank partograph | 1/4 (25) | 7/14 (50) | 60/125 (48) | 68/143 (48) |
Cord ligatures | 2/4 (50) | 8/15 (53) | 71/138 (51) | 81/157 (52) |
Any antibiotic injection | 1/4 (25) | 0/14 (0) | 12/127 (9) | 13/145 (10) |
Hydralazine injection | 1/4 (25) | 0/0 (0) | 29/32 (91) | 30/85 (35) |
Magnesium Sulphate injection | 1/4 (25) | 4/11 (36) | 58/100 (58) | 63/115 (55) |
Ergometrine injection | 1/4 (25) | 7/15 (47) | 75/138 (54) | 83/157 (53) |
Oxytocin injection | 1/4 (25) | 6/9 (67) | 36/52 (69) | 43/65 (66) |
Misoprostol tablets (100 or 200 μg) | 1/2 (50) | 1/6 (17) | 17/23 (74) | 19/31 (61) |
Normal saline | 1/4 (25) | 4/12 (33) | 49/79 (62) | 54/95 (57) |
Ringer’s lactate | 1/4 (25) | 6/13 (46) | 55/87 (63) | 62/104 (60) |
10% Dextrose | 1/3 (75) | 3/5 (60) | 25/30 (83) | 29/38 (76) |
5% Dextrose | 1/4 (25) | 3/12 (25) | 42/66 (64) | 46/82 (56) |
Staff experiences
Respondent characteristics
Staff experiences of providing care
At < facility name > we have a serious problem of not having ferrous sulphate. We have been out of stock for about a year now, and we informed the DMO office. They just tell us to wait because there is no stock. [FGD dispensary/health centre staff]
They come for supervision; they should also bring all the things we requested. [FGD dispensary/health centre staff]
This is a good thing because we do this to minimize the costs of taking another car separately going to the same places. [IDI CHMT]
We have a problem here of maintaining regular visits due to a shortage of funds for fuel. We do receive fuel but it is not enough to cover all the movements. [IDI CHMT]
You go to a facility and find there are no working tools, so you find it hard to assess them because they can’t do the duties to the required standard if they don’t have the working tools. And you keep on reporting with no action from the supplier. This really is a problem. [IDI CHMT]
A lack of drugs is a problem, […] Many facilities come to the hospital to ask for drugs. [FGD Hospital staff]
When we don’t have the equipment or drugs we apologise to them and they normally understand. [FGD dispensary/health centre staff]
People in the community say that we want money, that’s why we don’t give out drugs or vaccines. [FGD dispensary/health centre staff]
We worry about how to tell the patients that we don’t have drugs or vaccines when they come here expecting that they will get them. [FGD dispensary/health centre staff]
I wanted to use a suction machine because the baby had asphyxia, but there was no suction machine and these days it is not allowed to do mouth to mouth resuscitation. I decided to take a syringe to draw the dirty stuff out of the baby’s mouth to help the baby. [FGD Hospital staff]
For example the weighing scale for newborns is broken, and I am just using a sheet to hang the baby on the weighing scale for older children. [FGD dispensary/health centre staff]
Today I was helping a woman to deliver and after delivering I had to sterilize equipment using ‘jik’ [bleach] and by boiling; instead of using ‘setamide’ which is recommended. [FGD dispensary/health centre staff]
Then the mother delivered the baby but the baby was not breathing well; and there was no resuscitation machine so I had to use mouth to mouth resuscitation to help the baby. However, it is a risk to my health as I can be infected easily. [FGD dispensary/health centre staff]