Paper short abstract:

Nineteen months of research in communities and health facilities in Tanzania sheds light on quality of care, patient satisfaction, and trust between clients and providers by focusing on historical, social and institutional dynamics of facilities during obstetric care and crises.

Paper long abstract:

In an era of public health campaigns focused on encouraging women to give birth in biomedical health facilities with the assistance of skill attendants, little ethnography has been conducted in these settings, particularly in Tanzania where women still have a one in 44 lifetime chance of dying due to pregnancy related causes. Though many women successfully overcome barriers (e.g., poor transportation) to reach a health facility, too many still die within these settings. Nineteen months of ethnographic research in communities and biomedical health facilities in the Rukwa region of Tanzania suggests there are a number of ways in which this type of qualitative research can be particularly powerful in recommending new directions for healthcare reform that will continue to reduce maternal deaths. This research sheds light on how to improve quality of care, patient satisfaction, and trust between clients and providers by focusing on historical, social and institutional dynamics of health facilities, community interactions with biomedical providers, and the ways in which facilities work in practice versus their documentary representations. This research uncovered missing links between community members as clients and healthcare providers and administrators and, rooted in the mediating power of ethnography, suggests ways to improve patient satisfaction, communication, leadership, trust, and ultimately quality of care in a system perpetually lacking financial and human resources. Many health sector reforms are constructed far from implementation sites, often producing interventions not well grounded in the reality of those seeking healthcare services or those meant to dispense them; anthropology provides another option.