Abstract
BackgroundAn integrated and comprehensive hospital/community based health programme is presented, aimed at reducing maternal and child mortality and morbidity. It is run as part of a general programme of health care at a rural hospital situated in northern Tanzania. The purpose was through using research and statistics from the programme area, to illustrate how a hospital-based programme with a vision of integrated healthcare may have contributed to the lower figures on mortality found in the area. Such an approach may be of interest to policy makers, in relation to the global strategy that is now developed in order to meet the MDGs 4 and 5.Programme settingThe hospital provides reproductive and child health services, PMTCT-plus, comprehensive emergency obstetric care, ambulance, radio and transport services, paediatric care, an HIV/AIDS programme, and a generalised healthcare service to a population of approximately 500 000.Programme description and outcomesWe describe these services and their potential contribution to the reduction of the maternal and neonatal mortality ratios in the study area. Several studies from this area have showed a lower maternal mortality and neonatal mortality ratio compared to other studies from Tanzania and the national estimates. Many donor-funded programmes focusing on maternal and child health are vertical in their framework. However, the hospital, being the dominant supplier of health services in its catchment area, has maintained a horizontal approach through a comprehensive care programme. The total cost of the comprehensive hospital programme described is 3.2 million USD per year, corresponding to 6.4 USD per capita.ConclusionConsidering the relatively low cost of a comprehensive hospital programme including outreach services and the lower mortality ratios found in the catchment area of the hospital, we argue that donor funds should be used for supporting horizontal programmes aimed at comprehensive healthcare services. Through a strengthening of the collaboration between government and voluntary agency facilities, with clinical, preventive and managerial capabilities of the health facilities, the programmes will have a more sustainable impact and will achieve greater progress in the reduction of maternal and neonatal mortality, as opposed to vertical and segregated programmes that currently are commonly adopted for averting maternal and child deaths. Thus, we conclude that horizontal and comprehensive services of the type described in this article should be considered as a prerequisite for sustainable health care delivery at all policy and decision-making levels of the local, national and international health care delivery pyramid.
Highlights
An integrated and comprehensive hospital/community based health programme is presented, aimed at reducing maternal and child mortality and morbidity
Considering the relatively low cost of a comprehensive hospital programme including outreach services and the lower mortality ratios found in the catchment area of the hospital, we argue that donor funds should be used for supporting horizontal programmes aimed at comprehensive healthcare services
There is a growing consensus among the scientific communities and policy makers that improved intrapartum care linked to the health centre and hospital levels may be the most effective strategy to reduce the burden of maternal deaths in areas where the burden is high
Summary
We have reported from a wide-ranging, comprehensive and integrated intervention programme aimed at providing for as many as possible of the most pressing healthcare needs and demands of a predominantly poor population in a rural setting in a low-income country. We believe a close collaboration between government and voluntary agency facilities, especially in outreach programmes aimed at maternal and perinatal health, is essential in order to cover rural areas with adequate services. Such a programme increases trust and legitimacy, and improves the effects of the maternal and child health interventions. The priority setting mechanisms must be based on the values of the beneficiaries to secure trust, with an integrated approach This means ensuring that the facilities and care providers have a unified internal control system (planning, implementation, monitoring cycle), quality assurance procedures, remuneration and human resource policies that contribute to a productive and motivating organisational culture across all facilities. AIDS: Acquired Immuno Deficiency Syndrome; AMO: Assistant Medical Officer; ANC: Antenatal Clinic; BEmOC: Basic Emergency Obstetric Care; CEmOC: Comprehensive Emergency Obstetric Care; CHBC: Community Home Based Care Counsellor; CO: Clinical Officer; CSSC: Christian Social Services Commission; CTC: Care and Treatment Centre; DALY: Disability Adjusted Life Year; DHMT: District Health Management Team; DHS: Demographic Health Survey; EmOC: Emergency Obstetric Care; EPI: Expanded Programme of Immunization; HAART: Highly Active Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; HLH: Haydom Lutheran Hospital; ICD-10: International Classification of Diseases, version 10; IPT: Intermittent Presumptive Treatment; ITN: Insecticide Treated Nets; MDG: Millennium Development Goals; MMR: Maternal Mortality Ratio; MO: Medical Officer; NMR: Neonatal Mortality Ratio; PMR: Perinatal Mortality Ratio; PMTCT: Prevention of Mother to Child Transmission (used in relation to HIV); RCHS: Reproductive and Child Health Services; STD: Sexually Transmitted Disease; TBA: Traditional Birth Attendant; USD: United States Dollars; VA: Voluntary Agency; VCT: Voluntary Counselling and Testing; VHF: Very High Frequency (pertaining to radio systems); WHO: World Health Organization
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