Effect of Health System Transformation on Two Main Public Health Issues: Prenatal Care and Tetanus Toxoid Vaccination

Abstract

Background: Health care systems in many countries are changing, for a variety of reasons. This brings both opportunities and threats for public health professionals. Monitoring of preventive services becomes more important during these transition periods. Objective: It was aimed to determine tetanus toxoid vaccination and prenatal care coverage of mothers, to establish how routine services are affected by changes in the health care system. Methods: Two descriptive, cross-sectional studies were conducted in the city center of Gaziantep, Turkey by the Lot Quality Assurance Sampling Technique. The first study was applied just before transition, and the second was applied one year after transition to family medicine. Results: While a total of 82.8% mothers received first dose of tetanus toxoid in Gaziantep before the transition, it increased significantly to 90.1% (p<0.005) after the family medicine. Of the mothers, 82.8% received prenatal care before transition, it was 92.5% after family medicine (p<0.005). The percentage of mothers who gave birth in a health facility declined to 98.1% from 99.3%. The number of unacceptable lots dicreased from 22 lots to 10 lots after system change. Conclusion: A relatively high coverage was achieved for the first dose of tetanus toxoid and, prenatal care after family medicine. However, the coverage for booster doses are still under to be desired.