Monitoring of Maternal and Infantile care Activities

In the framework of quality assessment, the basic service for health care of Tunis introduced in 1997 a service managing tool for prenatal activity monitoring.This paper aims to present the way this tool should be used its setting up within the basic health structures and its principal effects on the quality process. Prenatal activity monotiring is a process that allows evaluation, control and dysfunction level identification of a health program; it also permits a microplanification in order to compensate for its failings. The first step consists in calculating the 5 following covering determining factors: target population, material or.human resources availability, the service at one's disposal's use rate, the appropriate coverage rate according to a precise way in which the consultations are linked to each other concerning this program and the effective coverage rate including the required quality indicator for the care. A graph permits to visualize these different rates. The second step consists in identifying the bottleneck and the most relevant correcting actions to be conducted in relation with either the available human resources or the material resources or the process of health care by using an "internal audit". Setting up this tool required many training sessions and supervisions for the Tunis health care services. It proved efficient enough in order to improve the actual coverage of the population especially in the responsibility area of the staff members for certain preventive programs as prenatal services or children's growth follow up. It allowed a better documentation of the consultation activity and the objective analysis of the inherent problems to the recommended program. The solutions were taken locally and dependes on the decision maker's will

[ health care demand in the district of Tunis]

This study aims at evaluating the morbidity of Tunis city inhabitants during the last 6 months preceding the date of the study [June 1998] and at locating the medical care points. It has been led with home interviews. The sample has been selected in a random way and is supposed to give a fair view of the whole districts of Tunis city; it includes 374 families and 1747 individuals. The socioeconomic indicators of the selected families are genuine with those of the Statistics National Institute and 88.8% of the interviewed families benefit of the welfare coverage. The mean of morbidity is of 2.6 yearly by individual and the health care is 3 yearly by individual: this includes an abstention of medical care up to 1.6% and self medication for 26.0% of individuals. The structure involved in the cares appeared respectively to be of public type in 37.5% of the cases, private in 26.5% and of a par public in 10.0%. For the urgency diseases [4.4%]. patients go to the hospitals in 31% of the cases; for the less urgent diseases [23.8%] patients go to the basic welfare structures in 23% of the cases. For the needs of prevention [8.5%], patients go to the basic structures in more than half of the cases. The study indicated clear trend towards more medication of Tunis city inhabitants though it represents the 1/5 of European people. The increasing demand of Tunis city inhabitants for medical care together with the growth of the private medical structures lead to a necessary new organization of the whole medical system in Tunisia