Open Access Research article

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study

Happiness P Saronga1*, Els Duysburgh2, Siriel Massawe1, Maxwell A Dalaba3, Germain Savadogo4, Pencho Tonchev5, Hengjin Dong6, Rainer Sauerborn7 and Svetla Loukanova7

Author Affiliations

1 Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania

2 International Center for Reproductive Health (ICRH), Ghent University, Ghent, Belgium

3 Navrongo Health Research Center, Navrongo, Ghana

4 Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso

5 Clinic of Surgery, University Hospital “Dr. G.Stranski”, Pleven 5800, Bulgaria

6 Centre for Health Policy Studies, School of Public Health, Zhejiang University, Hangzhou, China

7 Department of Public Health, University of Heidelberg, Heidelberg, Germany

For all author emails, please log on.

BMC Health Services Research 2014, 14:96  doi:10.1186/1472-6963-14-96

Published: 28 February 2014



Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning.


This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described.


The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency.


Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.

Antenatal care; Childbirth; Cost; Unit cost; Quality; Efficiency; Rural area; Tanzania; Health care provider