(2011; 67 pages)
This report outlines the preliminary results of an ongoing assessment survey on the quality of paediatric care conducted by the Ministry of Health and Social Welfare in the United Republic of Tanzania. Mainland Tanzania has 21 administrative regions and 113 districts. The country has a pyramidal referral structure of health care with public and private dispensaries, health centres and district, regional and national hospitals managed by the Government and by non‐governmental and faith‐based organizations. The survey reported here covers 69 hospitals managed by the Government and faith–based organizations across regions of Mainland Tanzania.
Millennium Development Goal 4 aims for a reduction in child mortality. Quality of care is an important factor in reaching this goal. While under‐five mortality has decreased in Tanzania, the rate in hospitals remains unacceptably high with 75% of these deaths occurring in the first 24 to 48 hours after admission. Most of these deaths are preventable and the application of appropriate measures, such as proper assessment, treatment and care, could reduce the number of deaths significantly.
The goal of the survey is to establish baseline data and identify gaps to be addressed in order to improve the quality of paediatric care in Tanzanian hospitals. The specific objectives of the survey are to:
- assess the administrative and logistics support in the provision of care for sick children;
- assess the knowledge and skills of health workers in the management of care for common childhood illnesses;
- assess the availability of essential medicines, supplies and equipment at health facilities necessary for the provision of quality care;
- support the establishment of a system for improving the care of children in the respective facilities...
The results varied greatly across the measured variables and from region to region. Overall the assessment results are poor, particularly in clinical assessment. They show that of the 82 variables measured none of the hospitals scored more than 75%. Of the 69 hospitals assessed, 42 60.9% had total scores of less than 50%. The highest scoring regions were Mwanza and Mbeya, while the lowest scoring regions were Lindi and Mtwara. Government hospitals scored lower than faith‐based hospitals in most of the areas assessed.
Emergency care, diarrhoea assessment, management of severe malnutrition and newborn care were among the worst scoring variables. Compared with the assessment of clinical conditions, HIV/AIDS testing, counselling and treatment performance were high scoring. The presence and availability of appropriate and adequate human resources scored poorly. Less than 25% of the facilities fully met the standards for qualified staff providing care to children, with over 50% of facilities partially meeting the standards.
The availability of standard treatment guidelines, essential medicines and equipment were among items assessed as part of the administration and paediatric ward assessments.
Findings show a lack of adequate and updated treatment guidelines in all hospitals. The availability of essential medicines as per the Essential Medicines List was poor; with just over one third of hospitals having the medicines on the list. Less than 25% of the hospitals included in the survey had essential equipment and supplies...