Scale-Up of Doppler to Improve Intrapartum Fetal Heart Rate Monitoring in Tanzania: A Qualitative Assessment of National and Regional/District Level Implementation Factors

Marya Plotkin, John George, Felix Bundala, Gaudiosa Tibaijuka, Lusekelo Njonge, Ruth Lemwayi, Mary Drake, Dunstan Bishanga, Barbara Rawlins, Rohit Ramaswamy, Kavita Singh and Stephanie Wheeler
Additional contact information
Marya Plotkin: USAID’s Maternal and Child Survival Program/Jhpiego, Washington, DC 20036, USA
John George: UNICEF, Dar es Salaam, Tanzania
Felix Bundala: Ministry of Health, Child Development, Gender, the Elderly and Children, Dar es Salaam, Tanzania
Gaudiosa Tibaijuka: USAID’s Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
Lusekelo Njonge: USAID’s Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
Ruth Lemwayi: USAID’s Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
Mary Drake: USAID’s Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
Dunstan Bishanga: USAID’s Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
Barbara Rawlins: USAID’s Maternal and Child Survival Program/Jhpiego, Washington, DC 20036, USA
Rohit Ramaswamy: Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Kavita Singh: Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Stephanie Wheeler: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA

IJERPH, 2020, vol. 17, issue 6, 1-17

Abstract: High-quality intrapartum care, including intermittent monitoring of fetal heart rates (FHR) to detect and manage abnormalities, is recommended by WHO and the Government of Tanzania (GoT) and creates potential to save newborn lives in Tanzania. Handheld Doppler devices have been investigated in several low-resource countries as an alternative to Pinard stethoscope and are more sensitive to detecting accelerations and decelerations of the fetal heart as compared to Pinard. This study assessed perspectives of high-level Tanzanian policymakers on facilitators and barriers to scaling up use of the hand-held Doppler for assessing FHR during labor and delivery. From November 2018–August 2019, nine high-level policymakers and subject matter experts were interviewed using a semi-structured questionnaire, with theoretical domains drawn from Proctor’s implementation outcomes framework. Interviewees largely saw use of Doppler to improve intrapartum FHR monitoring as aligning with national priorities, though they noted competing demands for resources. They felt that GoT should fund Doppler, but prioritization and budgeting should be driven from district level. Recommended ways forward included learning from scale up of Helping Babies Breathe rollout, making training approaches effective, using clinical mentoring, and establishing systematic monitoring of outcomes. To be most effective, introduction of Doppler must be concurrent with improving case management practices for abnormal intrapartum FHR. WHO’s guidance on scale-up, as well as implementation science frameworks, should be considered to guide implementation and evaluation.

Keywords: Doppler; scale-up; intrapartum care; fetal heart monitoring; Tanzania; qualitative (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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