Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure:  a strategy towards achieving Universal Health Coverage in Tanzania

Abstract Background: Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). This study aimed to understand the public sector's efforts to improve the infrastructure of primary health facilities between 2005 and 2019. We assessed the construction rates, geographic coverage, and physical status of each facility, surgical safety and services rendered in public primary health facilities. Methods : Data was collected from existing policy reports, the Services Availability and Readiness Assessment (SARA) tool (physical status), the Health Facility Registry (HFR), implementation reports on infrastructure development from the 26 regions and 185 district councils across the country and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. Data was descriptively analyzed so as to understand the distribution of primary health facilities and their status (old, new, upgraded, under construction, renovated and equipped), and the service provided, including surgical servic­es. Results: Of 5,072 (in which 518 are Health Center and 4,554 are Dispensaries) existing primary health care facilities, the majority (46%) had a physical status of A (good state), 33% (1,693) had physical status of B (minor renovation needed) and the remaining facilities had physical status of C up to F (needing urgent major renovation or complete reconstruction). Only 33% (1,673) of all health facilities had water and 5.1% had telecommunication system. Between 2015 and 2019, a total of 419 (8.3%) health facilities (Consisting of 350 health centers and 69 District Hospitals) were either renovated or constructed and equipped to offer safe surgery facilities. Of all Health Centers only 115 (22.2%) were offering the CEMONC. Of these 115 health facilities, only 20 (17.4%) were offering the CEMONC with all 9-signal functions and only 17.4% were offering Blood transfusion services. Conclusion: Despite the achievements in infrastructure development and upgrading, still there is a high demand for good physical statuses and functioning of primary health facilities with capacity to offer essential and safe surgical services in the country also as an important strategy towards achieving UHC. Key Words: Infrastructure, primary health facilities, safe surgery and Universal Health Coverage