Table 2 Key messages

Key messages

1. Novel analysis of subnational variation in health systems inputs: This is the first study to use GIS mapping techniques to visualise subnational health system readiness for care at birth across mainland Tanzania, and particularly to better understand this variation by examining finance and other inputs.

2. Widespread subnational gaps in health system readiness for care at birth: No region meets the benchmarks for all four health systems building blocks including for health finance, health workforce, health facilities, and commodities.

3. Explaining variation in care at birth services for rural women: Significant correlations were found between proportion of rural women delivering in a health facility, and by Caesarean section with health system readiness indicators including human resources density, health facility density, availability of essential commodities, and quality of care. However, some outlier Tanzanian regions, e.g., Kagera, demonstrate improved delivery of care at birth services for rural women despite receiving suboptimal resources; which has implications for similar settings, and needs further investigation to understand why and how this is occurring.

4. Research agenda: Future research to improve care at birth services for rural women should take into account data on governance and leadership, demand and community engagement, and efficiency in use of resources. Further investigation is needed into understanding positive outlier regions within Tanzania demonstrating improved service provision despite facing resourcing challenges. Considerable research is also needed to improve health systems input data, particularly on health workforce and standard benchmarks.