Abstract
BackgroundTanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right. Nevertheless, the quality of maternal health care is disproportionately low. The current study sets to understand maternal health services’ delivery from the perspective of rural health workers’, and to understand barriers for and better strategies for realization of the right to quality maternal health care.MethodsSemi-structured in-depth interviews were conducted, involving 11 health workers mainly; medical attendants, enrolled nurses and Assistant Medical Officers from primary health facilities in rural Tanzania. Structured observation complemented data from interviews. Interview data were analyzed using thematic analysis guided by the conceptual framework of the right to health.ResultsThree themes emerged that reflected health workers’ opinion towards the quality of health care services; “It’s hard to respect women’s preferences”, “Striving to fulfill women’s needs with limited resources”, and “Trying to facilitate women’s access to services at the face of transport and cost barriers”.ConclusionHealth system has left health workers as frustrated right holders, as well as dis-empowered duty bearers. This was due to the unavailability of adequate material and human resources, lack of motivation and lack of supervision, which are essential for provision of quality maternal health care services. Pregnant women, users of health services, appeared to be also left as frustrated right holders, who incurred out-of-pocket costs to pay for services, which were meant to be provided free.
Highlights
Tanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right
Selected codes male HW take care of women in absence of female HW “I am not going there they are all male HW” male HW hinders women to deliver at the facility A female HW at ANC will attract more women A nurse giving care to three patients at the same time Opting for home delivery due to lack of confidentiality They receive more support from home during delivery We provide less care to our patients
Health system presents a gap in provision of quality maternal health care, due to unavailability; inaccessibility and unacceptability of resources
Summary
Tanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right. In order to avert these deaths the World Health Organization (WHO) recommends, the access to, among other things; family planning services, antenatal care, delivery services, emergency obstetric care (EmOC), and post-natal care [2]. Such services need to be available, affordable and acceptable to all women [3, 4]. Despite the effectiveness of these interventions, in many countries maternal mortality remains unacceptably high, because essential maternal health services are not available as required This can be considered as a violation of the human rights to health [5, 6].
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