Striving to fulfill women's right to quality maternal health care in a constrained health care system:: Experiences of health workers in rural Tanzania
Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Background: Attempts to understand maternal health as the human right perspectives has been used for over decades now, but still there is low facility coverage, shortage of health care personnel, inadequate equipment and medicine that hinders women’s access to quality maternal health especially in low resources countries. Health workers plays a key role as crucial interplay for optimal provision of the health care services as well as interconnection between health system and women. The aim of this study was to explore the experiences of health care professionals in delivering maternal health care services in a rural Tanzanian setting. Using human right to health perspective, the study set to understand maternal health services delivery in term of accessibility, availability, acceptability and quality, and to understand why and what factors/barriers affected the realisation of the right to quality maternal health care.
Methods: We conducted eleven in-depth interviews among health workers from primary facilities in rural Tanzania. Respondents involved in the study included; Medical attendants, enrolled nurses and Assistant Medical Officers. Interviews were conducted in Swahili language, and gathered data were transcribed, translated, and then analysed using thematic analysis. In the initial process data were coded openly, whereas authors assumed to have no preconception ideas, then in the second step, codes were examined and re-examined to identify their differences and similarities and fitted into groups to form selective codes. This process was guided by the conceptual framework, whereas similar codes were placed together to reflect domains of accessibility, availability, acceptability and quality domains as preliminary themes. These were later revised and labeled according to the contents of the data
Results: Health workers expressed that, ‘it’s hard to respect women’s preferences’- describing how women users perceived the health care services to lack respect and confidentiality as well as unacceptance of male health workers for delivery services. ‘Striving to fulfill women’s needs with limited knowledge and resources’- described efforts made by health workers in order to enhance availability and accessibility of services. Such efforts included working for long hours, treating more than one patient at the same time, skipping vacation, sending women to buy-, and borrowing medications and equipment from other facilities to ensure provision of maternal health care. Health workers also indicated ‘attempting strategies to facilitate women’s access to services at the face of transport and cost barriers’- which represented the need to refer women to higher facilities, with lack of reliable referral system, and the role of outreach activities to enhance access to health care to clients in remote areas. These efforts and strategies were done to deal with inadequate equipment and medications, shortage of health care workers and weak referral system but ended up with partial success.
Conclusion: Health care system, health workers experienced hardships which led them to become frustrated right holders as well as disempowered duty bearers. This amount to provision of suboptimal maternal health care which is unavailable, inacceptable, inaccessible and low quality hence violation of right to quality maternal health care. Fulfilling health workers’ rights by providing them with adequate training, sufficient supplies and other benefits, is essential to facilitate them to provide quality maternal health care services.
Place, publisher, year, edition, pages
2016. , 54 p.
Centre for Public Health Report Series, ISSN 1651-341x ; 2016:26
Women's right, quality maternal health care, health workers, Tanzania
Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-131581OAI: oai:DiVA.org:umu-131581DiVA: diva2:1075004
Health Centre Mkinga - Tanzania
Master's Programme in Public Health
2016-05-24, Umeå Universitet, Umeå, 14:00 (English)
Goicolea, Isabel, Associate ProfessorMkoka, Dickson A.
Coe, Anna-Britt, Associate Professor