Dissertations (Masters)-HME-SOPAM
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Item The contribution of pay for performance project on improving child immunisation rates: A case of Mkuranga health facilities(Mzumbe University, 2015) Lyimo, Frank JasperPay for performance is the project implemented in Tanzania with the aim to motivate health care workers to improve performance toward attainment of Millennium Development Goal number 4 and 5.The objective of evaluation study was to evaluate the contribution of Pay for Performance on improving child immunizations rate at Mkuranga health facilities. Cross-section evaluation study was conducted where 30 closed-ended questionnaires were provided to all 30 in charges of health facilities involved in the study, 8 in depth interviews were conducted purposively to key informants of the selected facilities. Baseline data of year 2010 before the project were compared with ones (2011-2014) after the project to see whether p4p motivate health workers in providing measles and polio zero vaccine. Proportion of bonus payment, number of training and supportive supervision were calculated and presented in figures and tables, thematic content analysis with the aid of Atlas ti software was used to assist analysis of recorded information. The results indicated that immunization rate in all health facilities involved were doubled from year 2011 to years 2014. Immunization rate shows that facilities with 3 number of supportive supervision had high rate of child immunization, other facilities with less training and bonus payment had almost similar trend with those with more training and bonus payments. The study revealed delays of bonus payment and worries about sustainability of the project. It was concluded that P4P play a big role in motivating health care workers in increasing rate of child immunized with polio zero and measles vaccine in Mkuranga health facilities. The increase might be associated with other factors rather than motivation trough bonus payment, training and supportive supervision alone. Other studies should be conducted to identify the real cause of this increase.Item Assessing factors influencing reporting of weekly diseases data from regions to Ministry of health and social welfare in Tanzania Mainland(Mzumbe University, 2015) Moshi, Solomon FrankBackground: Reporting weekly diseases data from regions to Ministry of Health and Social Welfare is one of method which is used to submit weekly diseases information from regions to the Ministry according to number of weeks in a year from 1st to 52th week. This method is a paper based, that enables diseases information to be available at the national level on time to allow for quick and important public health action. This is an evaluation study designed to assess factors which tended to influence weekly diseases data from regions to Ministry of Health and Social Welfare, to determine technical challenges and determine measures to improving the reporting design. Methodology: The quantitative study design was conducted in Tanzania mainland which consist all regions. A primary data type was collected through structured closed questionnaire which was administered to a total of 25 respondents’ samples size that was 100% countrywide, since each region was represented by single reporter. Data was processed and analyzed by using Microsoft Excel 2010. Results: Findings showed that there was higher understanding of factors which influenced reporting. Findings indicate that 100% of the participants were Health officers, 68% were regional IDSR focal person who understood well the system of reporting weekly disease data. The evaluation also revealed technical challenges associated with reporting; whereas 88% of participants acknowledged to have incurred cost during reporting, 71% viewed that approving weekly diseases data contributed to untimely reporting. Finally, there were measures identified for improving reporting; these include feedback report, supportive supervision and availability of IDSR guidelines. Conclusions: The evaluation concludes that, the ineffectiveness of reporting weekly diseases data was due to several reasons which include weekly reporter having many responsibilities, approving and signing weekly diseases by RMO before submission,costs of reporting incurred by reporters and weak or no supportive supervision and feedback.. So the evaluation recommends that government through its ministry must take responsibilities of making sure that reporting forms are available. The Ministry and its development partners should take esponsibilities to elevating the costs incurred by IDSR focal person. The study also recommends to the Ministry and RMHT to strategize on how to speed up reporting, and that weekly disease data should not be approved only by RMO but other RHMT members. Lastly, the study recommends that the Ministry set aside some fund and schedule a time table to enable them to conduct supportive supervision from National level to Regional levelsItem Quality of cataract services in Zanzibar: A case of Mnazi Mmoja hospital(Mzumbe University, 2015) Makame, Abass TahaInspite of efforts taken to overcome the cataract related blindness, Zanzibar as one among sub-Saharan countries are far behind the WHO target for good visual outcome following cataract services. Zanzibar claimed to have 41% good visual outcome out of 95% WHO target while the reasons are not much clear, hence a quest to assess the quality of cataract services provided in Zanzibar in terms of: competency of human resource available, availability of medical requirement and level of staff compliance with the standard operation guidelines. To address the evaluation objectives a case study design was applied to assess the quality of cataract services in Zanzibar involving both qualitative and quantitative techniques. The evaluation had drawn its sample from cataract service providers, cataract patients and the heads of eye department in Mnazi Mmoja Hospital through convenient and purposive sampling procedures. Findings obtained from questionnaire, interview, observation and documentary review show that the case study hospital has only 39.1% of required skilled personnel. It has modern equipment and machines for quality cataract services. However, keratometer, B scan and YAG laser were not functioning while antibiotics for post operative and follow up care services were not adequately available to fulfill the requirements of all patients. About 75% cataract patients were not adequately received preliminary care as per guideline. 75.6% of patients received partial assessment for cataract surgical services while by 88.5% were fully assessed for critical events and anticipated variation as per standards. The evaluation conclude that the cataract services offered in the case study hospital was not as quality as expected since it had the following short comings: shortage of qualified human resources necessary for cataract services, shortage of medicines particularly antibiotics; lack of standard service guidelines, dysfunction of critical equipment and machines, and also inability of cataract service providers to adhere to standard guidelines.Item Perceptions and experiences of young key populations on provision of responsive services for men who have sex with men & female sex workers: A case of PASADA project, Dar es salaam Tanzania(Mzumbe University, 2016) Shayo, John AmbrosePresent disparities in access to HIV services among KPs are significant. Stigma and discrimination, violence, disciplinary harassment by police and social environments are major issues which fuel increased HIV vulnerability among KPs, thus availability, access, and uptake of HIV prevention, treatment, care, and support for MSM, sex workers and their clients are limited. In response to the problem both local and international NGOs collaborated in initiating and implementing a responsive programme for KPs in Dar Es Salaam, Tanzania. PASADA, PSI and the Government of Tanzania implement a programme with a focus on providing care and treatment services to MSM and FSWs in Dar Es Salaam. A descriptive qualitative study using in depth interviews and focus group discussions were employed. Seven KPs (Four MSM, three FSWs) were enrolled for in depth interviews and one FGD conducted with peers of KPs. Three service providers were recruited for in-depth interviews from PASADA clinic centre. We used Andersen’s Behavioral Models for vulnerable populations and a framework for Monitoring and Evaluation for marginalized populations as a framework to interpret on the perceptions and experiences on health seeking and influences on the provision of services by health providers for KPs The results highlight on the concerns of service providers lack of skills and low motivation related to the provision of services to KPs. KPs demonstrated awareness and knowledge of the comprehensive responsive services and issues which hinder accessibility. There was general unawareness of Hepatitis B and C, vaccination and appropriate prevention information among the group. The qualitative study underscores the significance of information on both HIV risks and acceptable, effective HIV prevention options for MSM and FSWs. Learning and skills development should be available to the wider KPs community. Drop-centre interventions may be excellence sites to address health problems experienced by MSM and FSWs.Item Assesment of water sanitation and hygiene practices among school children in Sengerema District Council(Mzumbe University, 2015) Temu, Consolata E.Background: Poor hygiene practices and conditions create a serious public health threat to school children. This evaluation aimed to assess School Water sanitation and Hygiene (SWASH) project established for providing better school environment to the school children and better hygiene conditions to all pupils. The specific objectives included assessing the alignment of the project to the national guidelines, hygiene practices behavior of the pupils as well as the perception of implementers of this program. Methodology: The study was qualitative and a descriptive cross sectional study design where a formative evaluation approach was employed. A sample size of 8 primary schools with 80 people was used in the study. One on one interviews, Focus group discussion and observations checklist were used to extract data from the study participants. Data was analyzed through content analysis technique with the help of Atlas ti software, where codes, themes and quotes were created Results: The overall results showed that none of the 8 schools had met the standards of school WASH. 2 district implementers and 16 school teachers were interviewed while 62 pupils (56%) females and (43%) males were in a focus group discussion. The majority of Pupils seem to have fair knowledge on hygiene related diseases but poor practice on hygiene practices. 85% of interviewed pupils never wash their hands after toilet use and 83.87% of them do not like their school toilets despite of them using it. The implementation process is a big challenge to the implementers of both sides (district and schools). Conclusion: The evaluated primary schools have poor hygiene conditions mainly due to poor planning and implementation of the programmed. The school children practice poor hygiene behavior due to lack of knowledge and means made available for them to practice safe hygiene practices. Lack of water and sanitation facilities is stated as the main obstacle for the pupils to practice safe hygiene behavior. The implementers find that the biggest challenge in the implementation of School WASH is poor or too little budget for the project and poor commitment of the government in running school WASH. Poor partnership and co- ordination between the department of education and health are also observed as the driving challenges to the implementation of school WASH. Efforts should be made by the government in improving these challenges.Item Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund(Mzumbe University, 2015) Denis Francis SwaiBackground: In Tanzania, Community Health Fund (CHF) was initiated in 1996 with the aim of implementing a community Based Health Financing Scheme through volunteer membership contribution as additional income to improve access to quality health care service for marginalized rural community. The evaluation was conducted to assess factors that influencing Community Health Fund member’s satisfaction with treatment services offered through Community Health Fund membership. Methods: A cross-sectional study design was employed that involved 153 respondents for which allowed collection of data that provided a descriptive estimate of the population parameters. The study was guided by Donabedian conceptual framework where by questionnaires were designed to assess structures, process of service delivery and treatment outcome as attributes of satisfaction. A sample size of 153 respondents was calculated by statalcl 13 (64-bit) within the effect size of 0.7– 0.8 one sample (Alpha = CI=95%, α=0.05, two-sided). Two health facilities were involved in the exit interview where by respondents were selected and interviewed based on their inclusion criteria. Results: A bigger proportional of female 55(60%) and 40(60%) in Likombe and Mikindani compared to male 37(40%) and 21(34%). A big proportional of respondents revealed that structures of health facility include availability of adequate Health Care Providers (HCPs) and medicines influence their satisfaction (p=0.05). Most of respondents were happy with the quality of available medical supplies and it was statistically significant at satisfaction level (p=0.02). The process of service delivery indicate that CHF members spend more than one hour to receive treatment service in health facility from their first contact and there was significant association between time spent and satisfaction(p=0.02). However, significance association was found between happiness with treatment and overall satisfaction level with services (p=0.03) though members do not feel much difference from being a CHF member and other patients. viii Conclusions: All three attributes - Structure of the health facility, process and treatment outcomes significantly influence CHF members satisfaction of treatment services provided through CHF membership. However, the availability of medicines, and qualified HCPs have great influence in the Satisfaction with structures, while there is a significant influence of time in satisfaction with process of services provision and treatment results have significant association with service provided.Item Evaluation of the effect of integrated logistics system on essential medicine availability at health centres and dispensaries in Tanzania: A case of Mbeya city council(Mzumbe University, 2017) Francis, Lucia.In response to the problem of shortage and wastage of essential medicines, Tanzania introduced the supply chain system for reporting and requesting medicines and other medical supplies to the respective Government owned health facilities called integrated logistics system, despite ILS introduction the health facilities have continued to face the same problem. This evaluation study was intended to evaluate the effect of Integrated Logistics System activities and their contribution to essential medicines availability in the selected 11 Health Facilities in Mbeya City Council. The specific objectives were(i)To determine the stock status of essential medicine for the past 12 months and on the day of assessment.( ii)To examine the extent to which integrated logistics system activities i.e. records keeping, store management, filling report and request forms are implemented as designed (iii) To explore factors influencing the implementation of integrated logistics system(iv)To examine the contribution of integrated logistics system activities i.e. records keeping, report submission time, filling report and request forms on essential medicine availability. The study employed explorative and descriptive study design where by both quantitative and qualitative methods of data collection were used. The study findings revealed that though the facilities had shortage of essential medicines (Tracer medicines) on average the availability on the day of assessment was found to be 87%, for the period 2015/2016 was 78% and for July 2016 to March 2017 was 92% which show improvement on availability compared to 2014 HMIS data which was 70% availability. The results suggested that ILS activities implementation as designed had an effect on essential medicines availability to health facilities. Its activities implementation depend on each other and if implemented as designed can contribute to the availability of essential medicines though other factors like availability of fund and medicines at MSD needs to be checked on which did not included in this study. The result found that ILS activities were not implemented as designed by the most of health facilities and this challenge had to be rectified by MoHCDGEC, Regional and district level together with their facilities.Item Assessment of the quality of postnatal care services: A case study of Mbeya District Council(Mzumbe University, 2015) Lotto, Theopista, DavidBackground: Postnatal care services consists of care given to the mother and her new- born for the first six weeks following birth, which enable health care providers identify post delivery problems and provide treatments promptly. This evaluation was conducted to assess the quality of postnatal care services following the unpublished report from Health Management Information System of the District which showed an increase in the number of maternal and infant death within six weeks post delivery. Methods: The evaluation used descriptive cross sectional study design in which quantitative approach was employed to collect and analyze evaluation data. The study was also guided by Donabedian conceptual framework based on structural and process components. A total of 355 clients attending postnatal care services in five selected facilities participated in an exit interview. Observational checklist adopted from the WHO implementation guideline was used for assessing resource availability. Data was analyzed using STATA version 13.0. Results: The findings established that health facilities that were involved in the study had basic resources to render quality postnatal care, however, there were some deficiencies in both structure and process components for provision of Post Natal Care (PNC) services. None of the five facilities had separate PNC room equipped with facilities for provision of quality services. Discussion and policy implications: The evaluated health facilities scored below 90%, based on agreed standard as set by World Health Organization which implies PNC services offered was sub-standard. Mbalizi Hospital and Inyala Health Centre had the average score of 77%, Santilya dispensary scored the third (75%) followed by Ilembo Health Centre 70% and the last was Igoma dispensary which scored 68% which is equal to partial quality. There is a need for the management of Mbeya District Council to plan for improvement of health facility infrastructures by constructing separate rooms for PNC to be able to provide quality health services and reduce neonatal and maternal death and ensure privacy to patients and clients.Item Process evaluation on the implementation of mwanzo bora nutrition program on the reduction of childhood stunting: A case of Kilolo District in Tanzania(Mzumbe University, 2018) Chisanga, Helen, JNutritional status of children is an important ending measure of their health status. Thus, child care and feeding practices has been recommended as a major solution to improve under-five survivals and promote healthy growth and development. This evaluation aimed to assess the implementation process of Mwanzo Bora Nutrition Program (MBNP) in reduction of childhood stunting at Kilolo district council in Iringa, Tanzania. The evaluation employed formative approach guided by a cross-sectional design. The evaluation enrolled a total sample size of 161 respondents. The sample included mothers of children/caregivers between 0-23 months enrolled in MBNP, community health workers and CHMT officials who were purposely and randomly selected. Data were obtained by using questionnaires, interviews and focus group discussions. Quantitative data were entered and analyzed by using SPSS software version 20 whilst simultaneously qualitative data were analyzed manually. Data were collected by using structured questionnaire, focus group discussion and in depth interview. Descriptive statistics were carried out, Chi – test was done to determine relationship between variables by using IBM SPSS version 20. The results revealed that 98% of mothers had knowledge about infant and young child feeding. There was no significance difference between knowledge of infant and young child feeding and practices especially on complementary food practice and breast feeding. However, significance difference was reported on the initiation of breastfeeding at (p≤0.05). Likewise, there was significance difference (p≤0.05) between knowledge of Mwanzo Bora Nutrition Program and its practices. Finally majority of the respondents (80%) had reported to have hand-washing equipment's; and among them 51% reported to have started using the equipment's after implementation of the program. The study concludes that use of hand-washing facilities improve hygienic condition and ultimately results on the reduction of childhood illness. Challenges associated with insufficient funds, shortage of human resources and poor community participation to some extent limited the implementation processItem Evaluation of sanitation facilities in relation to communicable diseases in government primary schools in Mkinga District Council(Mzumbe University, 2018) Mosha, Irene VBackground: Water, Sanitation and Hygiene related diseases remain one of the most significant child health problems worldwide. Infections such as cholera, malaria, trachoma, bilharzias and diarrhoea are on increase in our communities. The most affected ones are children. These diseases not only affect children‟s physical development but also school attendance and academic performance. The challenges of School Water, Sanitation and Hygiene (SWASH) are more pronounced in developing countries unlike the developed world. This study evaluated the Sanitation facilities in government Primary Schools in Mkinga district council. Methodology: The study used cross sectional study design, drawing a sample of 285 respondents. Purposive sampling was used to select Key informants. Simple random sampling was used to select Ward Development Committee (WDC), Village Government members, members of school committee, and teachers and snowball sampling was used to select Pupils, Parents/community and Private sector, Local artisans and construction companies. Primary data were collected through questionnaire and direct observation. Content analysis method was used to analyse the data from in-depth interviews. Questionnaire data were analysed using SPSS computer software where descriptive statistics such as frequencies and percentages were deployed. Results: A total number of 30% of Mkinga public primary school have sanitation facilities. Pupils whom practice hygiene are 30% but not all pupils are provided with protective gears. Community members agreed that the hygienity of water sources was poor are 36%. Conclusion: The sanitation facilities are insufficient in government primary schools. Pupils practice hygiene but not all pupils are provided with protective gears. The hygiene practice among community members is very poor due to the farming activities, which are conducted near the sources of water. Recommendations: The Government should ensure that, the district level guidance and support for compliance reflects the National regulatory framework. Use appropriate guidelines where standards do not exist.