Abstract
BackgroundThe postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania.MethodsProgram implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10).ResultsWhile physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment.ConclusionsProgram training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged.
Highlights
The postpartum period represents a critical window where many maternal and child deaths occur
Structural inputs Physical infrastructure, equipment and supplies were comparable across program and comparison Health Center (HC) (Fig. 2)
Across all HCs providers discussed the challenges imposed by limited space, when juggling the needs of different MCH services, including Antenatal care (ANC) and postpartum care (PPC)
Summary
The postpartum period represents a critical window where many maternal and child deaths occur. The postpartum period, from birth to six weeks after birth represents a critical window of time where many maternal and child deaths occur – largely due to preventable causes [1, 4]. In Tanzania, the Ministry of Health and Social Welfare (MOHSW) recommends that mothers and children receive a minimum of 4 PPC consultations at the following times: within 48 h of delivery, between 3 and 7 days, 8–28 days, and 29 to 42 days (Table 1) [5, 6]. Despite these recommendations and near universal completion of at least one antenatal care visit (96%), only 50% of deliveries in 2015 occurred in facilities and only 35% of women with a live birth outcome received a PPC checkup following delivery [7]
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