title: Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural District of Tanzania.
abstract: BACKGROUND
  Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).
  
  
  METHODS
  In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach.
  
  
  RESULTS
  Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation.
  
  
  CONCLUSIONS
  The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.
authors.affiliation: Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. mkokamalinga@yahoo.co.uk.
authors.forename: Dickson Ally
authors.initials: DA
authors.lastname: Mkoka
authors.forename: Isabel
authors.initials: I
authors.lastname: Goicolea
authors.forename: Angwara
authors.initials: A
authors.lastname: Kiwara
authors.forename: Mughwira
authors.initials: M
authors.lastname: Mwangu
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
mesh_terms: D004389:Durable Medical Equipment / Q000600:supply & distribution*; D004630:Emergencies; D004632:Emergency Medical Services / Q000600:supply & distribution*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000600:supply & distribution*; D009774:Obstetrics; D004364:Pharmaceutical Preparations / Q000600:supply & distribution*; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies; D012423:Rural Health; D019035:Rural Health Services / Q000600:supply & distribution*; D013636:Tanzania
chemical_list: D004364:Pharmaceutical Preparations