2015年-世界发展银行全球_Health_Service_Delivery_in_Tanzania_78页_3mb

Summary of Tanzania 2014 Service Delivery Indicators (SDI)

Core Content

The Tanzania 2014 Service Delivery Indicators (SDI) report provides a comprehensive assessment of the quality and efficiency of health service delivery in the country. It is part of a broader initiative by the World Bank, African Economic Research Consortium (AERC), and African Development Bank to benchmark service delivery performance in health and education across Sub-Saharan Africa. The report focuses on three key dimensions of service delivery: availability of inputs, provider behavior, and institutional performance. It evaluates the effectiveness of service delivery in terms of diagnostic accuracy, adherence to clinical guidelines, and the availability of essential resources such as drugs, vaccines, and medical equipment.

Main Findings

What Service Providers Know

• Diagnostic Accuracy: Health providers correctly diagnosed 60.2% of five tracer conditions. Urban providers (66.0%) outperformed rural ones (50.0%). Clinical officers had the highest accuracy (67.0%), followed by doctors (64.4%), and nurses (37.3%).
• Comprehensive Diagnosis: 22.3% of providers correctly diagnosed all five conditions, while 38.6% could only diagnose at most two.
• Clinical Guidelines Adherence: Providers adhered to 43.8% of clinical guidelines for managing the five tracer conditions. For maternal and neonatal complications, adherence was lower at 30.4%, with doctors (35.7%) outperforming clinical officers (30.3%) and nurses (24.8%).

What Service Providers Do

• Caseload: The average health worker saw 7.3 patients per day. Private for-profit facilities had the highest caseload (10.8), while public facilities had the lowest (7.1).
• Absence Rate: On average, 14.3% of health providers were absent. Absence was more common in Dar es Salaam (21%) than in other areas. 90% of absence was approved, with doctors being three times more likely to be absent without approval (31%) compared to other staff (2%).

What Service Providers Have to Work With

• Drug Availability: 60.3% of priority drugs were available. Urban facilities had higher availability (69.4%) than rural ones (56.2%), with Dar es Salaam leading at 71.9%.
• Vaccine Availability: 80.1% of facilities had vaccines available, and nearly all with vaccines had functional refrigerators.
• Equipment Availability: 83.5% of facilities had the minimum medical equipment. Private nonprofit facilities had the highest availability (92.5%), while private for-profit centers had the lowest (24.9%).
• Communication Equipment: 36.3% of facilities had at least one communication tool (phone, radio, or computer). Computers were much less available in rural areas (9.4%) compared to urban (43%).
• Infrastructure Availability: 50% of facilities had access to all three basic infrastructures (toilets, clean water, electricity). Urban areas had better access than rural ones, and private for-profit facilities outperformed public ones (91.2% vs. 40.6%).

Key Challenges

• Inequitable Service Distribution: Quality and availability of services are uneven across regions, with urban areas (especially Dar es Salaam) performing better than rural ones.
• Skilled Human Resource Shortage: Despite low caseload and absence rates, provider knowledge and skills are insufficient to deliver quality services.
• Drug and Infrastructure Gaps: Drug availability, especially for mothers and children, remains a concern. Infrastructure access is limited, particularly in rural areas.
• Management and Supervision Issues: There is a need for improved management, supervision, and training of health workers to enhance service delivery quality.

Implications for Tanzania

• Progress and Gaps: Tanzania has made progress in reducing under-five and neonatal mortality, but maternal mortality remains a challenge.
• Need for Improvement: There is a significant need to improve the geographic distribution of quality services and increase the availability of skilled human resources.
• Accountability and Governance: Strengthening governance, including supervision and financial transparency, is essential for improving service delivery. The report highlights the importance of monitoring and accountability mechanisms to ensure effective service delivery.

Country Comparisons

Tanzania's SDI results are compared with other countries in Sub-Saharan Africa. Key findings include:

• Caseload: Tanzania's average is 7.3, lower than Kenya (15.2) and higher than Uganda (6.0).
• Absence Rate: Tanzania's rate is 14.3%, lower than Kenya (27.5%) but higher than Mozambique (23.9%).
• Diagnostic Accuracy: Tanzania's score is 60.2%, lower than Kenya (72.2%) but higher than Togo (48.5%).
• Clinical Guidelines Adherence: Tanzania's adherence is 43.8%, lower than Kenya (43.7%) but higher than Nigeria (31.9%).
• Equipment and Infrastructure Availability: Tanzania's equipment availability is 83.5%, higher than Kenya (76.4%) and lower than Nigeria (92.6%). Infrastructure availability is 50%, lower than Kenya (46.8%) and higher than Nigeria (34%).

Methodology and Implementation

• The SDI survey was conducted between May and July 2014, involving 403 health providers, 2,093 workers observed for absenteeism, and 563 health workers assessed with clinical cases.
• The survey included both public and private (for-profit and non-profit) health facilities, ranging from health posts to district hospitals.
• A multi-stage clustered sampling strategy was used, with districts as the primary sampling unit (PSU). The sample was representative of Dar es Salaam, other urban areas, and rural regions.

Conclusion

The SDI report underscores the importance of improving the availability of skilled human resources, essential medical equipment, and infrastructure to enhance health service delivery in Tanzania. While the country has made strides in reducing child mortality, there is a need for more targeted efforts to address the gaps in service quality and equitable access, particularly in rural areas. Strengthening governance, supervision, and financial management will be crucial in achieving the goal of "Health for All" in Tanzania.