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Factors affecting implementation of electronic logistics management information system (eLMIS) towards availability of essential medicine in selected primary health facilities in Karagwe District, Tanzania
(Mzumbe University, 2025) Nozobona,Emmanuel D.
Access to essential medicine is a global concern to heath of the population. In Tanzania it remains a significant challenge in strengthening primary health care services. Despite government efforts to strengthen primary health services including the implementation of electronic Logistic Management Information System (e-LIMS) to solve medicine challenges, many facilities still face shortage of essential medicine despite using a logistic system. However, there is limited data on the factors affecting its implementation. The study had three objectives: to assess the perceived availability of medicines, to identify institutional and individual factors affecting its implementation. The study adopted the Technology Acceptance Model (TAM), to carry out the study. A cross-sectional design was employed, utilizing both descriptive and inferential statistics specifically bivariate (OR) and multivariate logistic regression (AOR) for institutional and individual factors affecting implementation. Data were collected using questionnaires administered to 51 respondents from dispensaries to the district hospital. Stratified random sampling was used to sample primary health care facilities involved in the study and simple random sampling was used to select individual involved in the study from the selected facilities from each level On the availability of essential medicine, the study revealed that, 61% facilities frequently experienced medicine stock-outs, 65% often borrow medicine from other facilities to manage shortages. About 75% reported insufficient medicine to meet operational needs. On the institutional factors, the findings reviled that, facilities with logistics policies, standard operating procedures, (OR = 0.05, p = 0.021), facility dedicated budgets for logistics (OR = 0.4, p = 0.052). and adequate staff incentives (OR = 0.18, p = 0.043) were less likely to experience stock-outs. In the individual factors the study found that, facilities with staff who perceived eLMIS implementation as increasing their workload were more likely to experience shortages (OR = 2.28, p = 0.026). This study concludes that, primary healthcare facilities continue to experience frequent stock outs and drug expirations despite the implementation of the e-LMIS. The study recommends to address both institutional and individual factors to optimize e-LMIS implementation, thereby improving the consistent availability of essential medicines in primary healthcare settings.
Implementation evaluation of direct health facility financing at lower health facilities in Tanzania: A case study of Dodoma city council
(Mzumbe University, 2019) Bura, Joseph M.
Introduction: The Direct Health Facility Financing meant to ensure directly disbursing funds to the lower level health facilities and enabling them together with communities set their own health priorities so as to improve delivery of health services to achieve Universal Health Coverage (UHC). The main focus of the evaluation was implementation of Direct health facility financing in lower facilities in Tanzania, specifically it looked at Disbursement of funds,human resources availability and their capacity in implementation of DHFF, community participation and how social demographic affect the implementation ot DHFF.
Methodology: This process evaluation study was conducted in Dodoma City Council and applied the descriptive cross-sectional design. There were 99 Questionnaires, 12 in-depth interviews, 6 focused group discussions, and documentary review. A total of 22 health managers and 32 HFGC participated in an in-depth interview and Focused Group Discussions. Quantitative Data were imported to STATA 13 to run test statistics such as the logistic regression statistical test and chi-square statistical test that was used to assess the relationship and association between the dependent and independent variable respectively. While for qualitative data were transcribed read and re-read for completeness, and then uploaded in Atlas ti 7 to assist the data analysis process. The analysis was assisted by quere tool report.
Results: It was found that DHFF funds were disbursed very late from Central Government to facility account. Human resources for health number and their attitude is negatively affecting implementation of DHFF by 74 Percent and 96 Percent respectively, so there is critical shortage of health care providers and unpleasant attitude with insufficient capacity toward users of services. There is observed improvement in motivation due to autonomies in managing facilities funds by health care providers and improved financial fast-tracking of payments due DHFF programme being free from higher-level bureaucracies. Community participation is very low, only 14 Percent of the general population is aware on participation in the planning. It was found that social demographic factors like education, for example, none educated community 75 Percent attend tradition healing compared to the remaining 25 Percent who first attend facility services when they fall sick. Poverty, distance to the facility and local belief were important factor that is affecting implementation DHFF.
Conclusion: DHFF Funds are disbursed into the facility account untimely so resulting in an occasional shortage of essential commodities. There is critical of human resources shortage for health that affect implementation of DHFF. There is low community involvement in the implementation of DHFF and social demographic factors such as literacy, economy and distance to facilities is negatively vii affecting implementation of DHFF. We recommend the government to timely disburse funds, recruit human resources for health in the required number, sensitise community participation by preparing simple to understand manuals and advocate health promotion to enhance care seeking behaviours to the communities.
Conclusion: Unreliable funds, lack of awareness on SWASH project, poor sectorial coordination and non-consideration of MHHM issues as vital are major challenges impinging smooth implementation of SWASH project. Considerable measures are to viii be taken by government and project designers in areas of scale up, implementation and progress monitoring so as to ensure achievement of envisioned outcomes. recording and data reporting tools in the health facilities, despite that tools are available but still the quality of data remained doubtful due to data disparities observed in the documentary review across different level of response. Family planning data quality assessment is only performed at the District and in the Region level but rarely and improperly conducted at facility levels due to some observed challenges like inadequate knowledge for FP DQA, lack of skilled team, lack of standardized data quality assessment tools, mistrust of data collectors at different levels, data manipulation to fulfil donors requirements, parallel reporting and report overburden at the health facilities.
Outcome evaluation of voluntary medical male circumcision project on changes in knowledge, attitude and practices in Njombe town council
(Mzumbe University, 2018) Mhagama, Boniface
Despite of the Voluntary Medical Male Circumcision (VMMC) project to meet its target of scaling the coverage of male circumcision to 80%, there is no clear indication to whether this achievement is parallel to changes in knowledge, attitude and practices of community members of Njombe Town council. Therefore, this study evaluated outcomes of VMMC project on knowledge, attitude and practices towards Medical Male Circumcision (MMC) among community members of Njombe Town council. The study was conducted at Njombe Town Council in Tanzania, using descriptive cross sectional study design involving 156 respondents who were randomly selected from the study population. This study employed self-administered questionnaire method to collect data from respondents. Both inferential and descriptive analysis were applied to analyze study data using SPSS V.20. Study findings revealed that majority of respondents possess knowledge on MMC as one of the prevention methods of HIV, penile cancer and STIs. When attitudes of respondents towards MMC were assessed, many showed to have positive attitude. Moreover, the researcher found male circumcision is practiced in Njombe Town council. Knowledge, attitude and practices of community members towards MMC has been positively impacted by VMMC project, though it is not to the entire community. Hence more initiatives should be carried out by the government and other stakeholders to advocate MMC to community members of Njombe Town council.
Evaluation of the effect of pneumococcal conjugate vaccine 13 (PCV 13) and rotavirus vaccine on under five children hospitalisation and mortality: A case study of Maswa district
(Mzumbe University, 2018) Galishi, Anthony N.
Pneumococcal and Rotavirus infection continues to cause high level of hospitalisation and mortality in under-fives. In January 2013, Maswa district introduced PCV13 and Rotavirus vaccines in its immunisation programme to prevent children against pneumococcal and Rotavirus infection. This evaluation study investigated the effect of PCV13 and Rotavirus vaccines in under-five hospitalisation and mortality in Maswa district. The study adopted a case study design drawing a sample of 20 respondents who provided detailed information until the saturation level was met. Data were collected through in-depth interview, documentary review and observation. Some of the study participants were purposively selected due to their roles in IVD programme while others were conveniently selected at the facilities. Content analysis was used to analyse the data from in-depth interviews. Documentary data were analysed using SPSS computer software where descriptive statistics such as frequencies and percentages were deployed. The IVD programme was implemented following the national guideline. There was a decreased under-five hospitalisation and mortality due to pneumonia and diarrhoea diseases in Maswa district following introduction of PCV13 and Rotavirus vaccines.
Process evaluation of community led total sanitation programme in Njombe district council
(Mzumbe University, 2017) Msemwa, Boniface
Most of the diseases which affect the community are caused by poor sanitation. Improper hand washing or not washing hands after using a latrine, open defecation are the factors which contribute to the transmission of diarrhoea diseases. In order to prevent diseases resulting from unimproved sanitation, in 2011, the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDEC) introduced the programme to assist the community to increase the coverage of improved latrine and hand washing facilities by 50%. This evaluation study was conducted to assess the implementation of community led total sanitation programme in Njombe district council under the dimensions of knowledge of the community on Sanitation programme, identifying the households with improved latrine after the implementation of the CLTS programme, implementation of Sanitation programme and examining the progress, shortcomings, challenges and the lesson learnt of Sanitation programme. The evaluation adopted cross-sectional study design. Both quantitative and qualitative data were collected from 272 households in three wards using questionnaire, observational checklist and interview guide. The study revealed that CLTS programme has successively scaled up the coverage of improved latrine from 3% before implementation to 98.7% after implementing the programme. Moreover, the findings showed that households with functional hand washing facilities has increased up to 68% compared with the previous during baseline survey which was 3%. This study showed that implementation of CLTS programme in Njombe district council has brought high coverage of improved latrine and hand washing facilities among the community. Community led total Sanitation can be well implemented using available resources found in the programme area taking into consideration that proper triggering is well conducted. Njombe district council should continue to strengthen CLTS programme so that to attain the declaration of open defecation free (ODF).