Integration of infectious disease services (HIV, Malria and TB) with antenatal care services; an assessement of service availability and readiness in Tanzania. A secondary quantitative analysis of the Tanzanian Service Provision Assessment (2015)
Background Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and TB) during pregnancy. In response, the country adopted WHO’s latest antenatal care guidelines which recommends comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO’s service availability and readiness assessment framework, this study sought to assess the capacity of the Tanzanian Health System to provide ANC and integrated Malaria, TB and HIV services. Also, the study assessed the relationship of how components of the SARA framework resulted in actual service delivery during antenatal care. Methods Composite indicators of the five components of integration were constructed from primary datasets of the Tanzanian SPA. Appropriate descriptive and inferential statistical tests were employed to determine assess capacity of the health system to integrate the infectious disease area with antenatal care services. The results were disaggregated by background characteristics and location. Finally, a logistic regression model was created to explore relationships by reporting adjusted odds ratios. Results Generally, capacity to integrate malaria services were significantly higher compared to Tuberculosis and HIV services. Diagnostic capacity were generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds of having all five components of integration and receiving integrated care was 1.9 (95% CI 1.4 – 2.7). Among these components, the strongest determinant (predictor) to pregnant women’s receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 1.7 – 4.5). Having infectious disease situated at same site with ANC service had no effect on receiving integrated care (AOR 1). Conclusion Towards a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious services especially HIV and TB services. Channelling investments into training health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and the unborn child.