Improving access to malaria and maternal health services in South-Eastern Tanzania: The role of institutions and livelihoods

Malaria-infection during pregnancy may lead to adverse consequences or even death for the woman and her child. In Tanzania, a country that is highly malaria endemic, malaria prevention strategies have been integrated into the antenatal care (ANC) services. Pregnant women attending these ANC services should receive Intermittent Preventive Treatment (IPTp) with anti-malaria drugs and a voucher for a subsidized impregnated bed-net (ITN). However, ANC attendance is often irregular and IPTp uptake is still low.

Little is known about socio-political and economic factors influencing access to maternal health services and malaria prevention among pregnant women and especially among pregnant adolescents.

This study funded by the KPFE “Jeunes chercheurs” program aimed at a better understanding of how institutions such as norms, rules and regulations influence pregnant women’s access to maternal health care and malaria prevention. A clear understanding of the functioning of these social processes is important as they do not only regulate access to health care services themselves, but also access to resources (economic, social, human, etc.) that are needed in order to be able to access the health system.

The objectives of the study were the following:

1.  To assess pregnant women’s access to malaria prevention in the study area

2. To investigate institutions and informal practices at the household and community level that affect pregnant women’s access to maternal health care services

3. To investigate institutions and informal practices at the health facilities that affect pregnant women’s access to maternal health care services

The study was conducted in close collaboration with the Swiss Tropical Institute, the Ifakara Health Institute (IHI) in Tanzania, and in particular with the ACCESS Programme at IHI. The study area encompassed the Demographic Surveillance System (DSS) site of the Ulanga and Kilombero districts in Morogoro Region, a rural area which is highly malaria endemic. A broad mix of different quantitative and qualitative methods was applied in order to allow for data triangulation.

Preliminary results show that IPTp delivery in the region has improved since 2006 due to better availability of Sulphadoxine-Pyrimethamine (SP), the anti-malaria drug used for IPTp, at the health facilities. However, IPTp uptake is still low, especially for the second dose.

Pregnant women’s access to malaria prevention and maternal health care services is strongly influenced by local norms and rules at the household and community level, but also by informal rules and formal regulations at the health facilities. Gender rules regulate women’s access to resources that are needed in order to be able to access maternal health services. Men as the household heads usually play a significant role in having the responsibility to supply their pregnant women with necessary resources (transport, financial, human and social resources). However, socio-cultural norms at the community level and the fact that men’s involvement at the ANC clinics has only recently been encouraged, constrain men’s motivation to fulfill their responsibilities.

Results from another study showed that pregnant women attending ANC clinics had a one in three chance to receive the services recommended by the national guidelines. Health-workers’ performance was influenced by inconsistencies between the guidelines and practical working tools such as the ANC cards, as well as by shortages of work supplies and human resources. In order to cope with difficult working conditions health-workers created their own organizational rules and routines that were not all compatible with the guidelines.

We conclude that a variety of institutions influence pregnant women’s access to maternal health care and malaria prevention at the household, the community and the health facility level. Studies on access to health care therefore need to focus also on social processes. Identifying and understanding norms, rules and practices at the community and health facility level are important in order to improve policy implementation in the field of maternal health.

 

Focus group discussion with men on men’s involvement in maternal health issues (K. Gross, 2009)

 

In-depth interview with a young mother and her mother (K. Gross, 2007)

 

                            Delivery facilities in a rural Tanzanian health-center (K. Gross, 2008)

 

 

Addresses

Karin Gross, PhD Candidate
Swiss Tropical Institute
Socinstrasse 57
P.O. Box, 4002 Basel
E-Mail: karin.gross@unibas.ch

                   

Research partner:                   

Iddy Mayumana, MA Sociology                                       
ACCESS Programme
Ifakara Health Research and Development Centre
Ifakara, Tanzania
E-Mail: imayumana@yahoo.com

 

Supervisors:

Prof. Dr. Brigit Obrist
Institute of Social Anthroplogy, University of Basel
Münsterplatz 19
4051 Basel

Swiss Tropical Institute
Socinstrasse 57
P.O. Box, 4002 Basel
E-Mail: brigit.obrist@unibas.ch

Dr. Flora Kessy, Senior Social Scientist
Ifakara Health Research and Development Centre
Dar es Salaam, Tanzania
E-Mail: fkessy@gmail.com