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). Quality health service provision together with equitable geographic access and service delivery are important components that constitute UHC. Tanzania has been investing in infrastructure development to offer essential safe surgery close to communities at affordable costs while ensuring better outcomes. 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. 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 (covering assessment of physical infrastructure, waste management systems and inventories for ambulances) and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. Data was descriptively analyzed so as to understand the distribution of primary health care facilities and their status (old, new, upgraded, under construction, renovated and equipped), and the service provided, including essential surgical services. Of 5072 (518 are Health Centers and 4554 are Dispensaries) existing public primary health care facilities, the majority (46%) had a physical status of A (good state), 33% (1693) had physical status of B (minor renovation needed) and the remaining facilities had physical status of C up to F (needing major renovation). About 33% (1673) of all health facilities had piped water and 5.1% had landline telecommunication system. Between 2015 and August 2019, a total of 419 (8.3%) health facilities (Consisting of 350 health centers and 69 District Council Hospitals) were either renovated or constructed and equipped to offer safe surgery services. Of all Health Centers only 115 (22.2%) were offering the CEMONC services. Of these 115 health facilities, only 20 (17.4%) were offering the CEMONC services with all 9 - signal functions and only 17.4% had facilities that are offering safe blood transfusion services. This study indicates that between 2015 and 2019 there has been improvement in physical status of primary health facilities as a result constructions, upgrading and equipping the facilities to offer safe surgery and related diagnostic services. Despite the achievements, 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. This is also inline with the National Surgical, Obstetrics and Anesthesia plan (NSOAP).

中文翻译：

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发展和升级公共初级医疗保健设施以及基本的外科服务基础设施：坦桑尼亚实现全民健康覆盖的战略。


支持初级卫生保健机构安全外科服务的基础设施开发和升级是实现全民健康覆盖 (UHC) 过程中的重要一步。提供优质卫生服务以及公平的地域获取和服务提供是全民健康覆盖的重要组成部分。坦桑尼亚一直在投资基础设施发展，以可承受的成本在社区附近提供必要的安全手术，同时确保更好的结果。本研究旨在了解2005年至2019年期间公共部门在改善初级卫生机构基础设施方面所做的努力。我们评估了公共初级卫生机构的建设率、地理覆盖范围和每个设施的物理状况、手术安全和提供的服务。数据收集自现有政策报告、服务可用性和准备情况评估 (SARA) 工具（身体状况）、卫生设施登记处 (HFR)、全国 26 个地区和 185 个区议会的基础设施发展实施报告（涵盖评估）物理基础设施、废物管理系统和救护车库存）和综合急诊产科护理 (CEMONC) 信号功能评估工具。对数据进行描述性分析，以了解初级卫生保健设施的分布及其状况（旧的、新的、升级的、在建的、翻新的和配备的）以及提供的服务，包括基本的外科服务。 在 5072 个现有公立初级卫生保健机构（518 个保健中心和 4554 个药房）中，大多数（46%）的物理状况为 A（良好状态），33%（1693 个）的物理状况为 B（需要进行小幅整修） ），其余设施的物理状态为 C 至 F（需要重大改造）。所有卫生设施中约 33% (1673) 拥有自来水，5.1% 拥有固定电话系统。 2015年至2019年8月期间，共有419个（8.3%）医疗设施（包括350个健康中心和69个区议会医院）进行了翻新或建造，并配备了设施以提供安全的手术服务。在所有健康中心中，只有 115 个（22.2%）提供 CEMONC 服务。在这 115 个卫生机构中，只有 20 个（17.4%）提供具有所有 9 个信号功能的 CEMONC 服务，并且只有 17.4% 拥有提供安全输血服务的设施。本研究表明，2015 年至 2019 年间，通过建设、升级和装备设施以提供安全手术和相关诊断服务，初级卫生设施的物理状况得到了改善。尽管取得了这些成就，但仍然对良好的身体状况和初级卫生设施的运作有很高的需求，这些设施有能力在该国提供基本和安全的外科服务，这也是实现全民健康覆盖的重要战略。这也符合国家外科、产科和麻醉计划 (NSOAP)。