Skilled Birth Attendants in Tanzania: A Descriptive Study of Cadres and Emergency Obstetric Care Signal Functions Performed
- First Online:
- 380 Downloads
Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.
KeywordsSkilled birth attendant Emergency obstetric care Signal functions Tanzania Sub-Saharan Africa
Assistant Clinical Officer
Assistant Medical Officer
Basic Emergency Obstetric Care
Comprehensive Emergency Obstetric Care
Emergency Obstetric Care
Health care provider
Kilimanjaro Christian Medical Centre
Kilimanjaro Christian Medical University College
Liverpool School of Tropical Medicine
Maternal and Child Health Aide
Millennium Development Goal
Maternal mortality ratio
Maternal and Newborn Health Unit
Ministry of Health and Social Welfare
Public Health Nurse
Reproductive and Child Health
Skilled birth attendant
Statistical Package for Social Science
United Nations Children’s Fund
World Health Organisation
- 1.WHO (2012) MDG 5: improve maternal health. http://www.who.int/topics/millennium_development_goals/maternal_health/en/index.html.
- 3.WHO, Unicef. (2010). Countdown to 2015 decade report (2000–2015): taking stock of maternal, newborn and child survival. Geneva, Switzerland: WHO and UNICEF. 2010.Google Scholar
- 4.UNICEF (2008) Fact of the week , http://www.unicef.org/factoftheweek/index_46985.html.
- 5.WHO (2009) Monitoring emergency obstetric care. A handbook. WHO, UNFPA, UNICEF & AMDD. Geneva, Switzerland: WHO press. http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf.
- 9.Van Lerberghe, W., & De Brouwere, V. (2001). Of blind alleys and things that have worked: History’s lessons on reducing maternal mortality. Studies in Health Services Organisation and Policy, 17, 7–33.Google Scholar
- 11.WHO. (2004). Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO. Geneva, Switzerland: WHO press.Google Scholar
- 12.International Confederation of Midwives (ICM) (2010). Essential competencies for basic midwifery practice. www.internationalmidwives.org.
- 15.National Bureau of Statistics (NBS). (2005). Tanzania Demographic and Health Survey 2004–2005. Dar -es- Salaam, Tanzania: NBS and ORC Macro.Google Scholar
- 16.National Bureau of Statistics (NBS). (2010). Tanzania Demographic and Health Survey 2010. Dar -es- Salaam, Tanzania: NBS and ORC Macro. 2011.Google Scholar
- 17.WHO (2011) World Health Statistics, http://www.who.int/whosis/whostat/2011/en/index.html.
- 18.Ministry of Health and Social Welfare (2008) The national road map strategic plan to accelerate reduction of maternal, newborn and child health in Tanzania 2008–2015. http//hdptz.esealtd.com/fileadmin/documents/Key Sector Documents/MNCH/One MNCH plan.pdf.Google Scholar
- 19.HSSE: Expectation of doctors and mid-level providers: alignment of regulation, training, and actual performance of emergency obstetric care by health care providers in Malawi and Tanzania 2009, http://www.amddprogram.org/d/sites/default/files/Expectations_MDs_and_MLPs.pdf.
- 22.MOHSW. Staffing levels for Ministry of Health and Social Welfare Departments, health facilities and health training institutions. Dar es Salaam, Tanzania. 2012.Google Scholar
- 23.Report, Moshi Urban Annual. (2010). Ripoti ya mama na mtoto katika manispaa ya Moshi. Tanzania: Department of Health, Moshi Municipal Council.Google Scholar
- 24.Kruk, M. E., Wladis, A., Mbembati, N., Ndao-Brumblay, S., Hsia, R., Galukande, M., et al. (2010). Human resource and funding constraints for essential surgery in district hospitals in Africa: A retrospective cross-sectional survey. PLoS Medicine, 7(3), e1000242.PubMedCentralPubMedCrossRefGoogle Scholar
- 25.WHO. (2006). The World Health Report 2006—Working together for health (p. 26). Geneva, Switzerland: WHO.Google Scholar
- 29.Ameh, C., Msuya, S. E., Hofman, J., Raven, J., Mathai, M., & Van den Broek, N. (2012). Status of emergency obstetric care in six developing countries 5 years before the MDG targets for maternal and newborn health. PLoS ONE, 7(12), e49938. doi:10.1371/journal.pone.0049938.PubMedCentralPubMedCrossRefGoogle Scholar
- 35.Ijadunola, K. T., Fatusi, A. O., et al. (2007). Unavailability of essential obstetric care services in a local government area of south-west Nigeria. Journal of Health, Population and Nutrition, 25, 94–100.Google Scholar