The structural quality of Tanzanian primary health facilities

Abstract

Structural quality is a key element in the quality of care provided at the primary level, which aims to offer health care interventions of proven efficacy. This assessment of the structural quality of Tanzanian primary health services indicated serious weaknesses in the available physical infrastructure, as well as supervision and other support, both for government and nongovernmental services and for dispensary and first referral-level services. Addressing these weaknesses is likely to require some additional funding and review of the functions of different groups of health care facilities within the primary care system. Although district health management teams have an important role to play in tackling the weaknesses, the existing division of management responsibilities indicates that they can only do so with the support of the regional and national levels of the health management structure. Study methods might be adapted to facilitate improved supervision and management.

PIP: A total of 58 primary health facilities were assessed in this study: 40 government dispensaries, 14 Catholic church dispensaries, and 4 health centers. The government health facilities were randomly selected from a sample frame of all facilities within the Morogoro region, stratified by district. Ten dispensaries, representing 20-90% of all dispensaries in the district, and one health center were selected from each of the four districts. Structural quality was assessed against expected standards. Overall performance (as judged from the totper variables) was not high. Median scores calculated across all criteria fell around 50% for all facility groups and all variables. Only three facilities out of the total of 59 were judged to perform at good levels against the 60% standard: two government dispensaries and one church facility. The church facility performed at good levels across all totper variables: the basic summary total (totper1), basic plus laboratory total (totper2), and basic plus laboratory and inpatient services total (totper3). Health centers only scored at similar levels to dispensaries. Health centers had several significantly lower scores for overall and curative care than church facilities. Curative care in government dispensaries was weaker than that in church facilities. Outreach service scores were uniformly low, but were least for church facilities whose performance was well below the standards for immunization sessions (monthly), home-visiting (weekly), and school visits (at least one in the previous two months). Although most facilities offered the range of services set by national standards, church dispensaries did not provide family planning services. However, in contrast to government dispensaries, laboratory services were usually available. In addition to the services provided in dispensaries, health centers did generally provide inpatient care. Overall, church facilities performed MCH services relatively poorly. Church facilities with inpatient services performed significantly better across seven of the eight MCH variables (the generally weaker activity of the group overall) than other facilities (p or= 0.05).