An Assessment of Progress and Challenges in the Implementation of the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) in Tanzania

Abstract

Introduction

There are significant disparities in access to safe and affordable surgery, particularly in LMICs. National Surgical Obstetric and Anesthesia Plans (NSOAPs) emerged as crucial national policy frameworks to address this gap. Although some Sub-Saharan African countries have developed and launched NSOAPs, there is limited information on evaluation of the progress and effectiveness of these plans. This study aimed to assess progress and challenges in implementing Tanzania’s NSOAP.

Methodology

We sent an electronic survey to all 26 Regional Health Management Teams (RHMTs) in mainland Tanzania to record their insights and understanding of the NSOAP and the state of Surgical Obstetric and Anesthesia (SOA). The RHMTs are key stakeholders in the NSOAP implementation as they oversee day-to-day implementation of all health interventions at the regional level.

Results

Only 4% of the surveyed RHMTs reported participating in the NSOAP development process, and 58% were unaware of the policy. The WHO Surgical Safety Checklist was rarely used, and surgical outreach programs were non-existent. There were gaps in the availability of SOA equipment and lack of radiological, intensive care and biomedical services. SOA specialists were few (1.96 specialists per 100,000 population). Most regions were excluded during the NSOAP dissemination meetings with no dedicated NSOAP coordinators at the regional level.

Conclusion

The NSOAP implementation faced various challenges in service delivery, infrastructure, equipment, human resources, information management and governance. Although slow progress has been made, there is a need for concerted efforts to achieve the NSOAP objectives. Future research should focus on comprehensive NSOAP evaluation and the establishment of an effective monitoring and evaluation framework.