In sub-Saharan Africa, primary health care facilities are essential for providing safe childbirth. However, the delivery volume in health facilities must be studied as an indicator of the effectiveness of primary care. Evidence indicates improved neonatal survival and fewer complications in facilities with higher delivery volumes.
In Tanzania there is an apparent paradox in an “excess” of delivery sites as 51·8% of rural institutional deliveries in Tanzania take place in primary health-care facilities. This excellent coverage risks being an obstacle to service quality: the volume of annual deliveries is too low, which prevents the few available workers to develop experience.
A possible solution may be centralizing the health system’s organization, reducing the number of rural delivery sites while maintaining accessibility to mothers in remote areas. This solution could help increase service quality, but any change should undergo evaluation and trials before being implemented.