THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE Baseline survey on quality of paediatric care in Tanzania NOVEMBER 2010 Published by the Ministry of Health and Social Welfare, Dar es Salaam, The United Republic of Tanzania. © 2011 Ministry of Health and Social Welfare, The United Republic of Tanzania Any part of this document may be reproduced in any form without the prior permission of the publisher provided that this is not for profit and that due acknowledgement is given. Any reproduction for profit must be made with the prior permission of the publisher. Copies of this report may be obtained from: The Permanent Secretary Ministry of Health and Social Welfare P.O. Box 9083 Dar es Salaam Tel: 255 22 2120261 Fax: 255 22 2139951 Table of contents Acknowledgments ................................................................................................................................ i Abbreviations........................................................................................................................................ ii Executive summary.............................................................................................................................iii Background ......................................................................................................................................iii Objective ...........................................................................................................................................iii Methods ............................................................................................................................................iii Results ...............................................................................................................................................iv Recommendations............................................................................................................................ v Conclusion........................................................................................................................................vi 1. Introduction................................................................................................................................... 7 2. Background ................................................................................................................................... 8 2.1 Tanzaniaʹs health system ................................................................................................... 8 2.2 Quality of care in children ................................................................................................. 9 2.3 Objective of the assessment ............................................................................................. 11 3. Methods ....................................................................................................................................... 12 3.1 Scope of the survey ........................................................................................................... 12 3.2 Performance criteria.......................................................................................................... 12 3.3 Grading performance ....................................................................................................... 12 3.4 Assessment teams ............................................................................................................. 14 3.5 Data entry and analysis.................................................................................................... 14 3.6 Statistical analysis ............................................................................................................. 15 4. Results .......................................................................................................................................... 15 4.1 Administrative review ..................................................................................................... 16 4.1.1 Overall performance .................................................................................................... 16 4.1.2 Hospital support........................................................................................................... 17 4.2 Clinical assessment ........................................................................................................... 25 4.2.1 Paediatric ward ............................................................................................................. 25 4.2.2 Monitoring..................................................................................................................... 25 4.2.3 Infection prevention and control................................................................................ 26 4.2.4 Care for children by qualified staff ............................................................................ 27 4.2.5 Case management......................................................................................................... 28 5. Newborn care.............................................................................................................................. 36 5.1 Delivery room/ward (nursery)........................................................................................ 37 5.2 Delivery of newborn care................................................................................................. 37 5.2.1 The neonatal resuscitation variables scored were:................................................... 37 5.2.2 For promotion of early breastfeeding and bonding the variables were: .............. 37 5.2.3 Clean delivery and newborn care variables were:................................................... 38 5.2.4 Prophylaxis variables were: ........................................................................................ 38 5.3 Sick newborn/neonate care.............................................................................................. 38 6. Further data analysis of the survey findings.......................................................................... 39 7. Discussion.................................................................................................................................... 45 7.1 Conclusion ......................................................................................................................... 48 8. Recommendations at regional level......................................................................................... 48 9. Recommendations at national level......................................................................................... 48 10. References.................................................................................................................................... 49 11. Annexes: Tables showing the overall hospital performance by region.............................. 50 Acknowledgments The Ministry of Health and Social Welfare (MOHSW) would like to extend its sincere appreciation to all the people who contributed to the development of this report. It is not possible to name all who have played a part in data collection and data entry; however the Ministry would like to mention a few whose particular dedication to this process made this report possible. Acknowledgements go first to all those individuals who participated in the development of the data collection tool and the check list, as well as those who assisted with the data collection. In the Reproductive and Child Health Section, MOHSW, we thank Drs Azayo Mary, Bundala Felix, Mr Meena John, Drs Msemo Georgina and Rusibamayila Neema. The MOHSW is especially grateful to the WHO Country Office as well as WHO HQ for the financial and technical support provided, especially to Drs Hill Sue, Iriya Neemes and Shija Rose. Finally, the MOHSW would like to thank the Principal Investigator and author of this report, Dr Kitundu Jesse from Muhimbili National Hospital, Department of Paediatrics, for leading this important work to its completion. Baseline Survey on Quality of Paediatric Care in Tanzania -- Page i Abbreviations APC Acute patient care ARI Acute respiratory infection AS Administrative score BF Breastfeeding CAS Clinical assessment score CPR Contraceptive prevalence rate CWS Childrenʹs ward score DPT3 Three doses of diphtheria, pertussis and tetanus vaccine EmOC Emergency obstetric care FBO Faith‐based organization IMCI Integrated management of childhood illness IMR Infant mortality rate IPD Inpatient Department IPTP Intermittent preventive treatment for malaria during pregnancy HSR Health System Reforms MDG Millennium Development Goal MNCH Maternal, newborn and child health MOHSW Ministry of Health and Social Welfare NMR Neonatal mortality rate OPD Outpatient Department ORS Oral rehydration solution ORT Oral rehydration therapy PAT Paediatrics Association Tanzania PHS Public health score PMTCT Prevention of mother‐to‐child transmission of HIV PNC Postnatal care ResoMal Rehydration solution for severe malnutrition RCHS Reproductive and Child Health Services RCM Referral care manual SAM Severe acute malnutrition SOP Standard operating procedure SM Standard met SPM Standard partially met SNM Standard not met TB Tuberculosis TS Treatment score TDHS Tanzania Demographic Health Survey U5MR Under‐five mortality rate WHO World Health Organization Baseline Survey on Quality of Paediatric Care in Tanzania -- Page ii Executive summary Background This report outlines the preliminary results of an