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ORIGINAL ARTICLE
Open Access

The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment

Erick Yegon, Japheth Ominde, Colin Baynes, Esther Ngadaya, Rehema Kahando, Justin Kahwa and Grace Lusiola
Global Health: Science and Practice August 2019, 7(Supplement 2):S315-S326; https://doi.org/10.9745/GHSP-D-19-00050
Erick Yegon
aEngenderHealth, Nairobi, Kenya.
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  • For correspondence: eyegon@engenderhealth.org
Japheth Ominde
aEngenderHealth, Nairobi, Kenya.
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Colin Baynes
bEngenderHealth, Washington, DC, USA.
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Esther Ngadaya
cThe National Institutes of Medical Research, Dar es Salaam, Tanzania.
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Rehema Kahando
dEngenderHealth, Dar es Salaam, Tanzania.
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Justin Kahwa
dEngenderHealth, Dar es Salaam, Tanzania.
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Grace Lusiola
dEngenderHealth, Dar es Salaam, Tanzania.
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Of the approximately 2,000 postabortion care (PAC) clients treated over 6 months in 2016, 55% chose a contraceptive method before discharge. Gaps in PAC availability and quality spanned multiple domains including human resource capacity and availability of supplies and contraceptives. While PAC providers generally expressed commitment to providing high-quality care, several facility and systems factors constrained their efforts, including limited training and facility space, lack of time, and supply chain challenges.

ABSTRACT

Introduction: In 2015, the government of Tanzania launched an effort to strengthen the quality of postabortion care (PAC), an integrated health service that includes treatment for abortion complications and provision of family planning counseling and voluntary services, in 25 facilities in mainland Tanzania and in Zanzibar.

Methods: To help guide the government’s initiative, we conducted a mixed-method study in 2016 using health facility surveys and in-depth interviews with health care workers that offer PAC. Surveys of the 25 facilities assessed the current use of services and readiness to deliver them. Provider performance in PAC was assessed through direct observation of client-provider interactions. In-depth interviews (IDIs) with 30 staff from the facilities provided qualitative information on priorities for PAC quality improvement.

Results: In the 6 months preceding the study, 2,175 PAC clients sought care at the facilities. Of these PAC clients, 55% chose a family planning method, of whom 6% chose a voluntary long-acting reversible contraceptive. The median facility PAC readiness scores were 45% for health centers, 49% for district hospitals, and 61% for regional referral hospitals. Direct observations of manual vacuum aspiration provision for PAC revealed that providers implemented, on average, 69% of the critical clinical steps. For misoprostol provision, PAC providers implemented, on average, 42% of the critical steps. Multilevel influences affected PAC providers’ work, often adversely, by shaping their confidence in their technical competency, confusing their role as health care workers and as clients’ peers, and coloring their attitudes toward clientele. The PAC providers also felt that their ability to implement their responsibilities was shaped by lapses in essential support and functionality of the health care system, as well as by social and cultural norms.

Conclusions: Technical assistance approaches that blend training, clinical quality improvement, systems strengthening, and social interventions that address demand-side barriers are needed to ensure providers achieve their potential and are able to deliver high-quality PAC.

  • Received: 2019 Jan 16.
  • Accepted: 2019 Apr 9.
  • Published: 2019 Aug 22.
  • © Yegon et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-19-00050

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Global Health: Science and Practice: 7 (Supplement 2)
Global Health: Science and Practice
Vol. 7, No. Supplement 2
August 22, 2019
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The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment
Erick Yegon, Japheth Ominde, Colin Baynes, Esther Ngadaya, Rehema Kahando, Justin Kahwa, Grace Lusiola
Global Health: Science and Practice Aug 2019, 7 (Supplement 2) S315-S326; DOI: 10.9745/GHSP-D-19-00050

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The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment
Erick Yegon, Japheth Ominde, Colin Baynes, Esther Ngadaya, Rehema Kahando, Justin Kahwa, Grace Lusiola
Global Health: Science and Practice Aug 2019, 7 (Supplement 2) S315-S326; DOI: 10.9745/GHSP-D-19-00050
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