RESUMEN
Based on the primary health care [PHC] principals and approaches, the District Team Problem Solving [DTPS] approach has been developed, which is an effective tool for improving performance of health services at the district level
Aim of the work: The aim of this study is to assess the DTPS approach in MCH services in El-Sharkia Governorate through conduction of Rapid Health Appraisal [RHA] in selected rural health units
Subjects and Methods: A comparative cross-sectional study was carried out at rural districts from 1[st] May to end of October 2004. Two units applying DTPS versus other two units at the same district not applying this approach. Data were collected through three semi-structured questionnaires, two check lists for units' structure and performance of the providers and reviewing the relevant medical records
Results: The DTPS units have suitable site, sanitary surrounding environment, well equipped laboratories and available relevant equipment. The units were the first choice for majority of the consumers and visited it frequently [>5 times]. Child immunization was the most service used while antenatal care was the least one used in both groups of units. The majority of consumers of DTPS units stated that they were accessible for them, doctors were available and were satisfied about waiting and the examination time compared with those in non DTPS units. The main reason of service under-utilization in the non DTPS units was the households' non satisfaction about the units' structure, doctor's unavailability and its long distance from their residence. As regard performance of health care providers [physicians and nurses] there was a significant difference among them in both groups as effective communication with patients was observed among higher percentage of those working in DTPS units. Majority of health care providers in DTPS units were satisfied about the units' site and structure, community participation, attendance rate and the level of service compared with other group of units. Lastly, the units applying this approach has accurate, clear, complete record data with suitable record keeping compared to other group of units
Conclusion and Recommendations: Majority of health care providers and consumers of DTPS units ascertained that it is an effective approach in improving some administrative skills and better utilization of health services in these units. So, the study recommended its wide application in Egypt for continuous improvement of the administrative skills of health care providers. Also, continuous training courses for them to improve their technical skill and updating their knowledge