Primary reproductive health care in Tanzania

Abstract

The introduction of community based reproductive health care programmes in Tanzania integrated within primary health care (PHC) programmes is discussed. These programmes should address safe motherhood, fertility awareness and sexually transmitted diseases (STDs), including AIDS. It is argued that the proposed primary reproductive health care programmes will only be sustainable if community participation is achieved, and if combined with improved woman and child health programmes. Sensitized communities, who have learned how to prioritize the problems identified and the appropriate actions to take, will have to be linked at the local level with well trained and supervised health workers, having proper equipment and supplies. A limited number of measurable indicators should give feedback on progress at any given time to both communities and health workers on mutually agreed objectives. The requirements demanded for these programmes add to the difficulties of a health service which experiences already considerable financial and other constraints. Major improvement in the financial support will be needed to raise quality and confidence in the health care system. Supplementation of domestic resources by considerable long-term external donor assistance is essential for filling the resource gap. Further, a more efficient and effective use of resources is required. This makes substantial health system reform and reallocation of public spending important, as well as consistent and coordinated support for district health systems.

PIP: Maternal mortality, unsafe delivery, close birth spacing, an unmet need for family planning, and sexually transmitted diseases (STDs) are major public health problems in Tanzania. However, the resources required to provide safe motherhood and reproductive health care have dwindled as a result of Tanzania's fiscal crisis. Proposed as a cost-effective solution to this dilemma is the integration of community-based reproductive health care services into existing primary health and maternal-child health care services. Key to the success of this strategy is community awareness of the causes of maternal and perinatal health problems and the contribution of local customs and beliefs to these problems. Also essential are improvements in the quality of institutional care through basic training, continuing medical education, supervision of traditional birth attendants, improved equipment and supplies, and a tiered system of referral. A limited number of measurable indicators should give feedback on progress at any given time to both communities and health workers on mutually agreed upon objectives. This strategy will require substantial health system reform, a reallocation of public spending, and coordinated government and community support for district health systems.