Dissertations (Masters)-HME-SOPAM

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Factors and challenges associated with loss of follow up visits among HIV/AIDS clients attending antiretroviral therapy in Ilala Municipal Council
(Mzumbe University, 2015) Salema, Judith
Background: The loss of follow up visits among HIV positive adults on antiretroviral therapy is a leading cause of morbidity and mortality in Tanzania. The loss of follow up visits brings a big challenge in Care and Treatment Centre (CTC) as many HIV clients are not attending clinics as scheduled. Broad Objective: To assess the factors and challenges associated with the loss of follow up visits among HIV positive adults attending CTC in Ilala Municipal Council. Methods: Cross sectional study design was conducted in Ilala Municipal Council involving HIV positive adults and health providers whereby data were extracted from CTC database and clients’ files. Data were obtained through structured questionnaires and were entered into Microsoft Excel and analyzed by using Stata version 13. Analysis for predictors was done using univariate and multivariate logistic regression where p value of <0.05 was considered as statistically significant. Results: 240 people were recruited in the study. 190 were patients, 50 were health workers, and most of the patients were females with the age ranging from 18-35 years amounting to 102 (54%). Lack of fare 72(60%), Stigma, shift from one clinic to another and use of traditional medicine found to be the factors contributing to the loss of follow up visits. However, lack of space (92%), shortage of health providers (94%), stigma and discrimination (90%), low motivation (94%) and work load (94%) were the challenges facing health providers during provision of services to HIV patients. Conclusion and Recommendations: The study found that the recording system of the patients’ information were poor, there were some clients who died, others were shifted to other clinics but the CTC term them as the loss of follow up visits therefore the data recording system should be strengthened.
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 Frank
Background: 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 52 th 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 responsibilities 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 levels
Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund
(Mzumbe University, 2015) Swai, Denis F.
Background: 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 estimates 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. 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.
Assessment of the quality of postnatal care services: A case study of Mbeya District Council
(Mzumbe University, 2015) Lotto, Theopista D.
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.
Nutrition care and support services of people living with HIV/AIDS at care and treatment clinic: The case study of Kagera Region Referral Hospital
(Mzumbe University, 2015) Tinkamwesigile, Nicolaus T
Introduction: A process evaluation on nutrition assessment counseling and support services of PLWHA at CTC conducted at Bukoba Region Referral Hospital, Kagera region with the aim of ascertaining level of programme implementation. Methodology: Mixed methods were used to assess evaluation dimensions. The semi structure questionnaire, interview guide, observation checklists and documentary review were used to obtain information about programme context, implementation process, reach, fidelity, dose, adaptation and mechanisms of the impacts of the services provided to PLWHA. Evaluation findings: The evaluation findings revealed that programme was fairly implemented with overall 51% score of weighted factors. The evaluated factors show that implementation process was 42.8% and fidelity of the implementation is 43.5%. While dose and reach of the programme implementation show 38.64% and 79.64% respectively. Stakeholders were less engaging to the programme services as contextual limiting factors and integration of nutrition services to CTC services note as mediator of mechanisms of achieved reach. Using weight trend of PLWHA as nutrition status determination index seen as programme adaptation Conclusion: The CTC had inadequate implementation process that include limited number of staff to assist nutrition services, inadequate equipment, materials and supplies to better optimal programme implementation. Implementation components such as fidelity, dose and reach are imbalance implemented for optimal quality programme implementation. Recommendation: Hospital and regional health managements and ministry of health through TFNC and NACP with their nutrition stakeholders are urged to improve CTC capacity to better nutrition assessment, counseling and support services implementation for betterment of PLWHA.
Nutrition care and support services of people living with HIV/AIDS at care and treatment clinic: The case study of Kagera Region Referral Hospital
(Mzumbe University, 2015) Tinkamwesigile, Nicolaus.T
Introduction: A process evaluation on nutrition assessment counseling and support services of PLWHA at CTC conducted at Bukoba region referral hospital-Kagera region with the aim of ascertaining level of programme implementation. Methodology: Mixed methods were used to assess evaluation dimensions. The semi structure questionnaire, interview guide, observation checklists and documentary review were used to obtain information about programme context, implementation process, reach, fidelity, dose, adaptation and mechanisms of the impacts of the services provided to PLWHA. Evaluation findings: The evaluation findings revealed that programme was fairly implemented with overall 51% score of weighted factors. The evaluated factors show that implementation process was 42.8% and fidelity of the implementation is 43.5%. While dose and reach of the programme implementation show 38.64% and 79.64% respectively. Stakeholders were less engaging to the programme services as contextual limiting factors and integration of nutrition services to CTC services note as mediator of mechanisms of achieved reach. Using weight trend of PLWHA as nutrition status determination index seen as programme adaptation Conclusion: The CTC had inadequate implementation process that include limited number of staff to assist nutrition services, inadequate equipment, materials and supplies to better optimal programme implementation. Implementation components such as fidelity, dose and reach are imbalance implemented for optimal quality programme implementation. Recommendation: Hospital and regional health managements and ministry of health through TFNC and NACP with their nutrition stakeholders are urged to improve CTC capacity to better nutrition assessment, counseling and support services implementation for betterment of PLWHA.
People's perception on mosquito net performance: A cross-sectional study in the north-western part of the Lake Zone in Tanzania
(Mzumbe University, 2015) Lukole, Eliud Andrea
The main aim of this study was to assess People’s Perception of Mosquito Net Performance in Muleba District in the North-Western Part of the Lake Zone of Tanzania. A cross-sectional survey and KAP survey were conducted a month apart. It was found that the sole reasons for not using bed nets in the study area were having not enough nets and bed nets being too old or poor condition. Half of the respondents continued to sleep under bed nets with poor conditions since they had no other alternatives. The attrition, survivorship and fabric integrity (LLIN with holes) rates were 36.85%, 57.76% and 60.15% respectively. Moreover, over 3 years more than 3 nets for every 10 nets distributed were lost because of wearing and tear, 5 nets survived out of 10 nets after 3 years and 4 nets sustained field condition for every net used. A proportionate hole index (pHI) was developed so that the integrity of net structure could be categorized. The pHI, IQR(Inter-quartile Range), median and standard deviation for HI were 3382.74, 2594.47, 3310.58 and 2551.50 respectively. There is wider dispersion of data on holes, and this is due to cluster geographical differences and differences in household composition between and within clusters. Based on study findings, mosquito nets are the main preventive measure against malaria used in Muleba. The population highly associates nets with malaria prevention. Nets with too many holes and more than three years old were perceived to be poorly performing in malaria prevention. Moreover,net attrition and survivorship and fabric integrity as elements of net durability showed significance difference between clusters because of geographical difference and the within cluster variation was due SES led by household composition. It is recommended that intensive and robust community-specific communication programmes should be devised by the government and/or other private institutions. Nets accessibility ought to be increased 3 years after free universal distribution through supply of subsidized nets in private shops so that families can at any time have access to them at lower costs. Pro- poor exemption policies can help the poorer group on equity bases.
Quality of cataract services in Zanzibar: A case of Mnazi Mmoja hospital
(Mzumbe University, 2015) Makame, Abass Taha
Inspite 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 fulfil 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.
Assessing factors influencing reporting of weekly diseases data from regions to Ministry of Health and Social Welfare in Tanzania Mainland
(Mzumbe University, 2015) Moshi, Frank Solomon
Background: 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 responsibilities 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 levels.
Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund
(Mzumbe University, 2015) Swai, Denis Francis.
Background: 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 estimates 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 significanly influence CHF members sutisfaction 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 assoaciation with service provided
Factors towards low contraceptive uptake: does providers’ capacity matter : A case in Morogoro District Council
(Mzumbe University, 2015) Stephen J. Mduma
The main objective of the study was to determine the role of providers’ capacity in enhancing contraceptive uptake. A descriptive cross sectional study design was used to a randomly selected 51 respondents of whom 26 were health providers and 25 were clients. The specific objectives were to determine magnitude of FP providers availability, to examine providers’ capacity in terms of training, skills, mentorship, experience, data generation and use for provision of FP services, to determine the magnitude of providers’ capacity for FP advocacy, to determine the degree of provider capacity in FP supply forecasting and to determine the level of provider capacity in meeting FP consumers’ choice. Findings revealed that, contraceptive uptake in Morogoro DC was 28% which was low compared to 37% of the region. Also, findings on availability of FP providers revealed that overall deficit of HCPs were 46.7% for dispensaries and 28.6% for health centers respectively. There was no statistically significant different between current contraceptive utilization and availability of health care providers with X2 Pr = 0.933>0.05 at 95% confident limit. Further findings on FP providers capacity revealed that lack of mentorship was at 66.6% for health centers and 100% for dispensaries and it was statistically significant with X2 Pr = 0.007 and correlation coefficient with P>|t| 0.006t 0.006 which is < 0.05 at 95% confident limit. Findings for FP/providers/clients decision making tool revealed that 92.31% of respondent reported that there was no tool available in their health facilities, statistically significant with X2 Pr 0.007 and correlation at P>t 0.006>0.05 at 95% confident limit. Conclusively: This research study had revealed that, consistent availability of contraceptives, health care providers, providers /clients’ decision-making tools and mentorship could enhance contraceptives uptake level in the community.
Assessment of quality of PMTCT service provided to HIV positive women and their HIV exposed infants in the Iringa District Council
(Mzumbe University, 2015) Kisika Firma Ambrose
This study was conducted to assess the quality of PMTCT services provided to HIV positive woman and their HIV exposed infants following the challenges of increasing dropouts. Specific objectives of the study were: to assess the input factors and their effects on the perceived quality to the satisfaction of the clients; and to assess the process factors and their effects on the perceived quality to the satisfaction of the clients. The study employed cross-sectional and descriptive designs in which data collection methods were questionnaire, in-depth interview, observation and documentary analysis. Data was analysed using Atlas it and SPSS version 16. The study findings revealed presence of some supplies and facilities requited for the provision of PMTCT services. However, it has been found that there are gaps/deficiencies in the structure, process and outcome that requited for providing PMTCT services. The study indicated that about half of the respondents had different views, both negative and positive, on the quality of PMTCT they received due to deficiencies in structural and process attributes that resulted in dissatisfaction. The study further showed deficiencies in structural attributes, in which majority of health care providers are not trained in PMTCT services, whereas it has been found that there is stock out of basic drugs for prevention of opportunistic infection. The study had opinions from CHMT concerning the problem of poor implementation at PMTCT services. The most and commonest problem is inadequate supervision. Further analysis indicated gaps in the process, where the majority of midwives demonstrated poor skills in counselling, whereas about half did not gather information. With regard to client provider interaction as they were not involved in the discussion. The study also revealed that none of the midwives used guidelines during provision of PMTCT services. In relation to history taking, it was observed that the majority of midwives did not obtain history and those few who attempted it came out with incomplete history. Almost all women and their HIV exposed infants were not examined. It is concluded that PMTCT services providers in Iringa District are poor quality.
Patients’ satisfaction under National Health Insurance Fund (MHIF):The case of Bugando Referral Hospital
(Mzumbe University, 2015) Mtwe, Joseph Nyamhanga
Patients’ satisfaction under National Health Insurance Fund (NHIF):The case of Bugando Referral Hospital Introduction: The National Health Insurance Fund (NHIF), scheme was initiated in 2003 by the government, with the aim of making health care services accessible to the formal sector employees. Objective: The main objective of this study was to assess the patients’ level of satisfaction under NHIF and factors influencing their satisfaction. Methods: The study employed a cross sectional study design involving 82 NHIF outpatients. Qualitative and quantitative approaches were employed; the data collection methods used includes questionnaire administration, focus group discussions and documentary review. Results: It emerged from the study that, insured patients had good expectation towards health services as well as good attitude with health service at the OPD, except poor attitude was noted on patients’ comfort ability towards health service. 37 (52.9%) respondents expressed poor attitude. Also 38 (54.2%) respondents indicated dissatisfaction on accessibility of the health services, especially enough space and seats. Furthermore, up to 36(51.4 %) respondents were dissatisfied with too long consultation time; and 34 (48.6%) respondents were dissatisfied with the service area at OPD, being inconvenient for the provision of health care to the insured patients.. It however emerged from the study that respondents were moderately satisfied with the availability of health services at the OPD and were satisfied with the quality of health services at the OPD. Conclusion: The study recommends action to be taken by NHIF scheme together with the hospital administration on addressing patients’ concerns for the purpose of improving the provision of health services. They should also include patient satisfaction strategies in their strategic plan for monitoring and evaluation of patient satisfaction under NHIF
Assessment of Health Management Information System (HMIS) perfomance in health facilities in Mbarali, Kyela, and Busokelo District Councils
(Mzumbe University, 2015) Sanga, Jactany L.
The purpose of this study was to assess the Health Management Information System (HMIS) Performance in health facilities in Mbarali, Kyela and Busokelo District Councils. The study adopted a mixed method design which enabled the study to triangulate the data and information. In this study, four methods of data collection were used, namely questionnaires, semi-structured interviews, focus group discussions and documentary review. The sample size was 49 respondents. PRISM DEAT was used in data analysis. The data analysis included the use of simple description of percentages, tables and graphs this was done using excel spreadsheet. The level of the HMIS performance was measured in terms of data quality and information use. The data accuracy at the facility level was observed using OPD Attendance, ANC and PMTCT MAT and observed to be higher than 95%. The use of information accounted to 65% of the health facilities stored meeting records and 100% of the reports requested were available at the facility and the district level, while 95.5% had a discussion at facility level on the HMIS, of these 83.3% made a decision after discussion, while 95.83% of health facilities referred their issue to higher levels for further assistance. The evaluation report recommend to improve HMIS skills specifically on data interpretation, use of information and problem solving, and the use of the performance improvement tools such as cause and effect analysis, flow chart, priority matrix, control chart, this may be achieved by developing a simplified HMIS training curriculum, conduct training of staff per facility and all health area management team members. The evaluation also recommends the promotion of a culture of information use, motivating health care providers and providing training on moral and ethical issues to improve information use for decision making.
Assessment of the quality of postnatal care services: A case study of Mbeya District Council
(Mzumbe University, 2015) Lotto, Theopista, David
Background: 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.
Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund
(Mzumbe University, 2015) Denis Francis Swai
Background: 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.
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.
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 Frank
Background: 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 levels
Quality of cataract services in Zanzibar: A case of Mnazi Mmoja hospital
(Mzumbe University, 2015) Makame, Abass Taha
Inspite 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.
The contribution of pay for performance project on improving child immunisation rates: A case of Mkuranga health facilities
(Mzumbe University, 2015) Lyimo, Frank Jasper
Pay 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.