Globally, every year 529,000 maternal deaths occur, 99% of which in developing countries with majority being in Sub-Saharan Africa. Maternal, Newborn and Child Health (MNCH) services depend on the accessibility, availability and quality of antenatal care (ANC), delivery and postnatal services. The aim of this study was to assess the health facilities’ capacity and readiness to provide MNCH services in Unguja Island, Zanzibar. A facility-based cross-sectional survey was conducted from May to June 2015 at public health facilities providing MNCH services. Data was collected by using the modified Service Availability and Readiness Assessment tool. Eighteen health facilities were assessed, two-thirds (66.7%, n = 12) of which were offering both maternity and reproductive and child health (RCH) services, 4 (22.2%) RCH services only, and 2 (11.1%) maternity services only. Readiness score for ANC services was 66% with high readiness scores in diagnostics services (89%) and equipment (69%). Overall, 14% offered all seven signal functions. Overall, delivery service readiness score was 48%. Overall readiness for comprehensive emergency obstetric and neonatal care services was 13%. Staff training and guidelines readiness score was 11%, while medicine and commodities score was 9%. The health facilities’ readiness in providing MNCH services remains inadequate in Unguja Island. Readiness in providing services was low for delivery and emergency obstetric and neonatal care services. Basic and advanced delivery services need to be improved in parallel with provision of necessary equipment, medicines and commodities and staff training for better MNCH service delivery.

Introduction

In Africa maternal healthcare service delivery is a huge challenge. This is compounded by inadequate and poor distribution healthcare facilities, lack of equipment and drugs (Obi et al., 2013; Singh et al., 2014). Zanzibar, like other African countries, also faces some challenges in addressing maternal and newborn healthcare services (WHO, 2014). The performance of the health sector remains unsatisfactory even though geographical coverage of the health facilities is considered equitably distributed to all regions and districts, and easily accessible to 95% of the population. Accessibility to health services is constrained mainly by poor quality of services due to lack of equipment and qualified staff (MoHZ, 2009). High maternal mortality still remains a serious challenge in Zanzibar with estimated Maternal Mortality Ratio (MMR) of 307 deaths per 100,000 live births (Herklots et al., 2017; HMIS, 2016; NBS, 2012). The major challenges in the reduction of maternal mortality include limited access to quality health services, a weak referral system and poor health-seeking behaviour among women (WHO, 2014).  

 Methods

2.1 Study Design This was a facility-based cross-sectional survey, which was conducted between May and June 2015 in Unguja Island, Zanzibar. 2.2 Study Area The study was conducted at Unguja Island, Zanzibar. Unguja Island is one of the two Islands in Zanzibar; the other being Pemba Island. Unguja Island is located 40 kilometres East of Tanzania Mainland. Unguja Island has a total of six districts with a population of 896,721 which is mostly concentrated in the Urban-West districts (NBS, 2013). 2.2.1 Selection of Study Sites and Health Facilities A simple random sampling method was used to select four districts out of six. The selected districts were North A, North B, West and Urban districts. These districts have high maternal mortality compared to other districts in Unguja Island (NBS, 2012). These districts have the total of 57 public health facilities, among which eighteen facilities were selected randomly to represent other facilities in the study area. We selected only public facilities because majority of people in the general community utilise them and also the healthcare services of the public facilities are the mirror which reflects the general health of the people in the country as well. The study involved facilities that provide maternal and newborn healthcare services. 

 Results

3.1 Health Facilities Information Eighteen health facilities were included in the study, of which 11 (61%) were primary health centre units plus (PHCU+), 4 (22.2%) primary health centre units (PHCUs), 1 (5.6%) tertiary hospital, 1 (5.6%) special maternity hospital and 1 (5.6%) primary health care centre (PHCC). All facilities were managed by the government. Nine (50%) were providing antenatal care (ANC) services, including other reproductive and child health (RCH) services, 7 (39%) were offering both ANC and delivery services while 2 (11%) were offering only delivery services. 

 Conclusion and Recommendations

The overall readiness to provide maternal and newborn healthcare services remains unsatisfactory in the health facilities in Unguja Island, Zanzibar, despite the satisfactory availability of maternal and newborn healthcare services. There is need to strengthen the antenatal care services at PHCUs through provision of equipment and necessary medicines and commodities. Both, basic and advanced delivery services need to be improved with provision of necessary equipment and supplies at all health facility levels. The Ministry of Health should strengthen the procurement and allocation chain for equipment and necessary medicines and commodities coupled with increasing the number of required human resource for health through new employments and training. There is need to improve skills of providers to ensure that at least minimum coverage of emergency obstetric careis in place in every health facility which is conducting delivery services. Study Limitations • The levels of facilities were different in terms of service provision. Despite all being public health facilities, they are managed by different level of authorities, this might under estimate or exaggerate the study findings. However, authors tried to describes each level by comparing the facility levels in the findings sections. • The selection of study units was limited only to public health facilities which might influence the study findings. However, the authors tried to balance by selecting those public facilities with high attendance of clients in order to represent other facilities to reflect the real situation in public facilities. • The findings of this study based on the reported of data on the day of data collection including previous three months of services offered by the facility, which might influence the findings.