Reaching the Poorest Children in Rural Southern Tanzania: Socio-cultural Perspectives for Delivery and Uptake of Preventive Child Health Interventions

Background: Much of the preventable child mortality and morbidity in the world occurs in Sub-Saharan Africa. Preventive interventions exist but coverage is low. This thesis examines sociocultural perspectives for delivery and uptake of preventive child health interventions, focussing on constraints and facilitating factors, the role of village health workers and the flow of informatioo relating to child health interventions in rural Southern Tanzania. Methods: Between 2004 and 2007, three linked qualitative studies were conducted in two districts of rural southern Tanzania. These included a rapid qualitative study, a longitudinal acceptability study of intermittert treatment for the prevention of malaria in infants, and an in-depth ethnographic study. The respondents include parents of young children, pregnant women, community leaders, service providers, programme implementers and decision makers at district, regional and national levels. The qualitative findings in this thesis are discussed in connection with quantitative data from household and health facility surveys that took place simultaneously in the study area. Results: Health system, socio-cultural, political and managerial factors all played a role in both facilitating and constraining service delivery and uptake. Constraints included mistrust among council health management teams, service providers, village leaders and community members, logistic and technical failures, absenteeism, delays in service provision, shortage of qualified service providers, provider attitudes, and user charges on supposedly free services. Village health workers had no clear management guidelines, leading to questionable roles, unrealistic expectations, and poor retention, despite being locally accepted. Flow of information about health interventions was inefficient, and client-friendly health education sessions were rare. Conclusions: Most constraints could be addressed through improved communication within and between health managemert teams and the community through district and health facility boards and service providers. Village health workers have the potential to deliver services to the unreached. The Ministry of Health guidelines on the recruitment arxI management ofVHWs would be a valuable first step towards this goal.