title: Public and private maternal health service capacity and patient flows in Southern Tanzania: using a geographic information system to link hospital and national census data.
abstract: BACKGROUND
  Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution.
  
  
  OBJECTIVE
  To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services.
  
  
  METHODS
  A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients.
  
  
  RESULTS
  The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap.
  
  
  CONCLUSIONS
  We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health programming. Inclusive partnerships could increase integration of FBOs into the public health care system and improve coordination and use of scarce resources.
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany; PatrikTabatabai@web.de.
authors.forename: Patrik
authors.initials: P
authors.lastname: Tabatabai
authors.affiliation: Laboratory for Geodata Analysis and Visualization, Department III Civil Engineering and Geoinformation, Beuth University, Berlin, Germany; Tanzanian German Programme to Support Health, German Development Cooperation/Deutsche Gesellschaft fuer Internationale Zusammenarbeit GmbH, Dar es Salaam, Tanzania.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Henke
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Sušac
authors.affiliation: Tanzanian German Programme to Support Health, German Development Cooperation/Deutsche Gesellschaft fuer Internationale Zusammenarbeit GmbH, Dar es Salaam, Tanzania.
authors.forename: Oberlin M E
authors.initials: OM
authors.lastname: Kisanga
authors.affiliation: Tanzanian German Programme to Support Health, German Development Cooperation/Deutsche Gesellschaft fuer Internationale Zusammenarbeit GmbH, Dar es Salaam, Tanzania.
authors.forename: Inge
authors.initials: I
authors.lastname: Baumgarten
authors.affiliation: Epidemiology and Biostatistics, Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Kynast-Wolf
authors.affiliation: Epidemiology and Biostatistics, Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Heribert
authors.initials: H
authors.lastname: Ramroth
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Marx
mesh_terms: D001723:Birth Rate; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D040362:Geographic Information Systems; D019538:Health Care Surveys; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000600:supply & distribution*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology
keywords: Tanzania; faith-based; health mapping; maternal health; public private; service capacity