title: Identifying implementation bottlenecks for maternal and newborn health interventions in rural districts of the United Republic of Tanzania.
abstract: OBJECTIVE
  To estimate effective coverage of maternal and newborn health interventions and to identify bottlenecks in their implementation in rural districts of the United Republic of Tanzania.
  
  
  METHODS
  Cross-sectional data from households and health facilities in Tandahimba and Newala districts were used in the analysis. We adapted Tanahashi's model to estimate intervention coverage in conditional stages and to identify implementation bottlenecks in access, health facility readiness and clinical practice. The interventions studied were syphilis and pre-eclampsia screening, partograph use, active management of the third stage of labour and postpartum care.
  
  
  RESULTS
  Effective coverage was low in both districts, ranging from only 3% for postpartum care in Tandahimba to 49% for active management of the third stage of labour in Newala. In Tandahimba, health facility readiness was the largest bottleneck for most interventions, whereas in Newala, it was access. Clinical practice was another large bottleneck for syphilis screening in both districts.
  
  
  CONCLUSIONS
  The poor effective coverage of maternal and newborn health interventions in rural districts of the United Republic of Tanzania reinforces the need to prioritize health service quality. Access to high-quality local data by decision-makers would assist planning and prioritization. The approach of estimating effective coverage and identifying bottlenecks described here could facilitate progress towards universal health coverage for any area of care and in any context.
authors.affiliation: Department of Public Health Sciences, Global Health-Health Systems and Policy Research, Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 17177, Stockholm, Sweden .
authors.forename: Ulrika
authors.initials: U
authors.lastname: Baker
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden .
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London, England .
authors.forename: Tanya
authors.initials: T
authors.lastname: Marchant
authors.affiliation: Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania .
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.affiliation: Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania .
authors.forename: Silas
authors.initials: S
authors.lastname: Temu
authors.affiliation: Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania .
authors.forename: Fatuma
authors.initials: F
authors.lastname: Manzi
authors.affiliation: Department of Public Health Sciences, Global Health-Health Systems and Policy Research, Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 17177, Stockholm, Sweden .
authors.forename: Claudia
authors.initials: C
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D007407:Interviews as Topic; D007749:Labor Stage, Third; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011181:Postnatal Care; D011247:Pregnancy; D019035:Rural Health Services; D013587:Syphilis; D013636:Tanzania; D055815:Young Adult