MAPPING HEALTH FACILITY CHARACTERISTICS AND LOCATION IN RURAL TANZANIA

Abstract

BACKGROUND: Optimization of care-seeking for pregnancy, delivery, and child health could reduce global maternal child mortality, especially in rural Africa. However, limited documentation of location, services, and staffing hamper facility-strengthening initiatives. OBJECTIVES: A mapping exercise collected basic information and global positioning system (GPS) data to characterize health facilities in two Tanzanian districts. DESIGN/METHODS: Research assistants administered a questionnaire about health facility information (i.e. maternal, newborn and child health (MNCH) services offered, staffing) verbally to in-charges at each site. GPS coordinates were recorded and delivery areas were photographed with Garmin Oregon 650 receivers. Frequencies were analysed in SPSS. Individual shapefiles for GPS waypoints and track logs were merged, producing single shapefiles of all health facilities and access routes. RESULTS: Over six days, 102 sites were visited, including three previously unlisted facilities. Four percent were hospitals, 10% health centres (HCs) and 85% dispensaries (91% public, 9% private). Most facilities were rural (86%) or mixed (9%). Ninety percent reported delivery capacity; 6% offered advanced delivery services (i.e. Caesarean sections, blood transfusions). 19,210 deliveries were reported in the preceding year (40% at hospitals, 19% at HCs, 41% at dispensaries); 46% of deliveries occurred at advanced delivery sites. On staff were a total of 20 medical officers for a doctor to population ratio of 1: 42,168. Other payroll staff included 95 clinical officers, 444 nurses, and 243 medical attendants. On day of survey, 50% of payroll staff were present; 22% of delivery-conducting sites lacked any mid-level health provider. Maps detailing precise location of all health facilities and road networks (including previously unknown roads) were produced. CONCLUSION: This mapping exercise combined technical and practical information, yielding creation of a useful database and functional maps. Visual representation of MNCH services was well received by project and health planners. This relatively small investment will subsequently enable higher quality of data collection and ease of project planning.