The use of spatial and geographic models such as Geographical Information Systems (GIS) was integrated into this study, whose aim was to assess the coverage of health care centers offering obstetric services in two rural areas of Tanzania, the Iringa and Ludewa Districts.

Both areas have a high density of health care facilities. However, the maternal and neonatal services they provide are inadequate; about half of the facilities do not have enough staff to guarantee full-time services and treatment. This means that in 48 facilities out of 70 in Iringa and 43 out of 52 in Ludewa, less than 100 assisted deliveries are provided annually.

At the same time, the availability of a good number of health care centers means that local populations can choose among them, with a preference for those that offer the broadest range of skilled services.

In this study the use of multiple and integrated spatial and geographic models made it possible to calculate the distances that local populations would have to travel if some of the health care centers were eliminated. Based on a hypothetical maximum walking distance of 2 hours, it was found that the number of facilities could be reduced by 40%, thereby freeing up resources that could then be reallocated to the remaining facilities in order to improve their performances. In such a scenario, only 7% of the population would live more than 2 hours’ walking distance from the nearest health care center. Thus there would be less coverage than before, but also a probable marked improvement in the quality of the services delivered.