mid-level providers tanzania godfrey mbaruku. date : 20 sep 1996 sourc e : un office for the...
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Mid-level providersTANZANIA
Godfrey Mbaruku
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Date : 20 Sep 1996
Source : UN Office for the Coordination of Humanitarian
Affairs (OCHA)
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Some facts about Tanzania
• Largest country in E.A-330,000sqkm
• Population-38M
• MMR-578/100,000(DHS);1,200(WHO)
• IMR-112/1000
• Dr:Population-1:20,000
• NMW:Population-1:10,000
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Reasons for MLP
• At independence,1961,only 3 local physicians
• No medical school(UEA)
• Projection for self sufficiency-
• Demanding geography
• 80%population-rural
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Skilled-care in Africa
• Is it needed?
• Is it available?
• Magnitude?
• Is it cost effective?
• What are the gaps?
• Do solutions exist?
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IMPORTANCEIn Africa
• Obstetrics:5% of women die in childbirth
• Perinatal death-5% of all pregnancies
• Injuries:5% of all deaths
• Increase with economy
For every 1 death,1disabled
(acute abdom,hernia,cataract,cong)
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Surgicallytreatable:25MilDALYs
(10% of all African DALYs)• Injuries- 10 million• Obstetrical complications- 4 million• Perinatal conditions- 2 million• Malignancies- 2 million• Congenital anomalies- 2 million• Cataracts & glaucoma- 1 million• Others- 4 million
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Do we meet the need?
Emergency Obstetric care as a measure
Met need for EmOC in 3 countries
(assume 15%deliveries complicated)
Met Need Drs/mil
• Mozambique 25% 30
• Tanzania 30% 20
• Uganda 5% 80
• Kenya 10% 60
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APPENDICITIS DEATHS, USA 1920 - 1960
0
2
4
6
8
10
12
14
16
1925
1940
1955
YEAR
DE
AT
HS
PE
R 1
00
,00
0
PO
P.
Series1
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WHAT HAPPENED,U.S.A?
• Safe blood: availability
• Antibiotics:discovery
• Trained anaesthetists(mostly nurses)
• Trained surgeons(mostly GPs)
• NOT:ICUs,monitoring,US,CT scans,respirators
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DOES IT COST TOO MUCH?
Annual cost per bed-5 hospitals
cost/bed(USD) GDP/capita
• Seattle USA 606,000 25,000
• Montry Mexico 68,000 3,900
• Kumasi Ghana 4,100 330
Bangladesh 3,600 350
TANZANIA 2,800 400
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However,genuine constraints
• Infrastructure-worn out buildings/equip
• Supplies-drugs,blood
• Inadequate budget-3-18USD per capita
• Transport-ambulances,roads,delays
• Staff-lack,skills,motivation
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Innovative solutions
A 7yr intervention program in Mmortality
(1987-1991)• Adressed issues:-• Staff-delegation,availability,skills(OJT)• Equipment-local repairs• Supplies-infusions,blood,drugs• Infrastructure-local fund raising,rehab• Management-regular audit
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Results
• MMR reduced by 50%(844-300)/100,000
• CFR reduced 40%(9-3.5)
• Increased attendances by 70%
• Increased patient´s satsfaction
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MMR-TRENDS
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Conclusions
• Mat mortality can be reduced but following essential
• Staff-training,motivation,presence(24hrs)
• Facilities-conducive
• Supplies-readily available
• Management-problem solving,audit