Dissertations (Masters)-HME-SOPAM

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An assessment of family planning program data quality: A case of Tarime District
(Mzumbe University, 2018) Sufian, Magetta S.
BACKGROUND: Family planning encompasses the accessibility of services, policies, information, attitudes, practices and commodities, that gives women, men, couples, and adolescents the ability to avoid unintended pregnancy and choose whether and or when to have a child and the preferable number of children. It is a cross-sectoral intervention that can hasten progress across the sustainable development goals (Starbird, 2016). Inadequate information and poor data quality on family planning intervention program seems to affect contraceptives uptake records across different level of response. Investing on family planning program data quality assessment can bridge up the gap between the observed differences. OBJECTIVES: The aim of this evaluation study was to determine the tools used by health care providers in recording and reporting family planning data at facility levels, to assess how data collected at different levels with different organisation have similarities, and exploring how different organizations assess family planning data quality collected at different levels. METHODS: The study was conducted at Tarime district in the DMO’s office, 19 health facilities, RMO’s office and Program’s office. Qualitative research design was used in this study, purposive sampling methods applied, the researcher used both primary and secondary data through questionnaires and documentary review respectively, and lastly data analysed by excel and Atlas.ti software. RESULTS: Family planning data recording and data reporting tools was available in all public health facilities visited, however, there were data disparity between health facility and district level, as well as District and Regional office. Though data similarities were observed between District office and program office. Data quality assessment was not vii done in the health facilities for almost 90% but seems to be done at the District and in the Regional levels in collaboration with partners. CONCLUSSION: The findings concluding that Family planning program use MTUHA book no 8 which consist of three books namely registers, tally sheet and summary report books as a data 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.
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.
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
Assessing the influence of health facility factors on utilisation of early infant diagnosis for HIV infection in Kilolo District Council
(Mzumbe University, 2016) Wilfred William Rwechungura
This study, which involved a sample of 200 respondents, was conducted in Kilolo District Council in Tanzania to assess the influence of health facility factors on utilizations of Early Infant Diagnosis of HIV infection (EID) services. The study problem was that there are HIV exposed infants who are enrolled in the EID programmed but they don’t access the intended services and hence the need for conducting the study. The specific objectives were (i) to evaluate availability of EID materials and its influence on utilizations of EID services in Kilolo health facilities; (ii) to assess availability of sample and results transportation system and its influence on utilizations of EID services in Kilolo health facilities; (iii) to assess the competence of healthcare workers and its influence on utilization of EID services at Kilolo health facilities; and (iv) to assess the satisfaction of mothers / guardians of HIV exposed infants on EID services provided in Kilolo health facilities. The study findings revealed that utilizations of EID service was indeed low (at 38%) as data suggested. Among contributing factors was inadequate EID materials at health facilities. Forty eight percent (48%) of the health worker respondents strongly disagree that there are adequate DBS materials at health facilities. On the same issue, when health workers were asked on whether they experienced stock outs of EID materials, fifty seven percent (57%) answered in the affirmative. The other finding was that health facility cares workers do not have sufficient skills for providing EID services. Forty three percent (43%) of the healthcare worker respondents reported that the sample and results transportation system is not reliable. The results showed that availability of EID materials and sample and results transportation system positively influence utilization of EID services at the health facilities whereas competence of healthcare workers influences negatively the utilization of EID services. This study recommends that the healthcare workers be trained in providing EID services and that arrangements be done for ensuring availability of EID materials, sample and results transportation system and availability of competent healthcare workers.
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
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 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 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.
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.
Assessment on implementation process of maternal health project on emergency obstetric care and neonatal services in rural settings: A case of Uvinza District Council-Kigoma
(Mzumbe University, 2016) Kimambo Haika Steven
Background: Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, maternal death due problems related to unimproved comprehensive obstetric has been documented. Objectives: The aim of this evaluation was to assess the implementation process more specifically on the community awareness with regards to emergency obstetric and neonatal care (EmONC).The goal of the project has been to improve maternal and child health age in a population by ensuring provision of quality health services by utilization of EmONC services by the community of Uvinza District Council. Methods: The study was conducted in four villages of Uvinza district in Kigoma region. A cross-sectional descriptive study was conducted involving 120 respondents. Semi structured questionnaire was used to capture information related to implementation process of World Lung Foundation. The focus was collected information on several issues such as assessing the level of community awareness in accessing EmONC services, identifying the roles of traditional birth attendants and challenges encounter by health care workers in facilities providing EmONC services. Evaluator randomly selected the participants to be included in the study. Results: The evaluation revealed institutional deliveries increased by 87.5% at CEmONC health centers, and 70% deliveries by caesarean section, the highest ever recorded. The level of community awareness in accessing EmONC services was high among the evaluation participants. Majority (87.5%) of the health care workers had received training supported by World lung foundation. The findings also revealed that traditional birth attendants have been undertaking early referrals of pregnant women to health facilities providing EmONC. vi Conclusion: The issue of 3 Ds (Delay in decisions making when to seek care, Decision of earlier referral and Decision on what time to start treatment) all these cut across as limitations to achieve millennium development goal number 5. Findings revealed that the maternal mortality rate (MMR) in all facilities decreased by 44% between January 2011 and June 2013(WLF report, 2013). Furthermore, there was a 70% increase in institutional deliveries in Project-supported facilities compared to a 30% decrease in non-Project-supported facilities; there were increased awareness of community in accessing care to health facilities providing EmONC services.
Effectiveness of result based financing programme on utilization of maternal health services in Urambo
(Mzumbe University, 2018) Njopeka, Abdilahi Nassor.
Background: Introduction of RBF to Africa resulted from increased maternal death and decreased national expenditure on health sector (Africa Progress Panel, 2010). In Tanzania, RBF was introduced in 2015, rolled-out to Urambo district in 2017. This study evaluated the worth of RBF on utilization of maternal health services through paying incentives, improving infrastructure and purchasing commodities to health facilities. Methodology: Quasi experimental evaluation study conducted in Urambo district where multistage sampling was used to select households from RBF facilities as intervention participants and non-RBF facilities as control participants. Baseline data was collected from DHIS 2, associations tested using Chi square (95%) and 0.05 P-value. Results: Institutional delivery cumulated 51% of incentives paid to health staff, implying that staff are motivated to perform duties with high incentives (20,720 Tshs/client) compared to the less paid of IPT 2 (1,240 Tshs/client) that demonstrated a drop of 11.7% after RBF implementation. The availability of 50% of medicines at maternity ward suggested the presence of other funds source. Changes from 0% to 61.3% state of building repair and an increase in availability of power and water sources by 82.9% and 50% respectively suggested improved facility infrastructures. Utilization of services increased for 43.3% in institutional delivery and 9.6% for prenatal visits >12wks were associated with incentives and infrastructure (P-values 0.006, 0.023; 0.001, 0.014). Conclusion and Recommendations: RBF was effective on utilization of maternal health services but limited to prenatal visits >12wks and institutional deliveries with effect size of 0.12 and 0.21 respectively. It is recommended that non-monetary form of incentive should be directed to clients in order to advocate the concept of RBF to the community, and the CHMT should provide technical support to health facility management team and make effort to community health education on the importance of completing four prenatal visits before delivery.
Evaluation of sanitation facilities in relation to communicable diseases in government primary schools in Mkinga District Council
(Mzumbe University, 2018) Mosha, Irene V
Background: 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.
Evaluation of the implementation process of health system strengthening program towards improving emergency obstetric and newborn care services: A case of selected health facilities in Kisarawe District
(Mzumbe University, 2018) Mwandiki, Martin F
Background: In this 21st century with well advanced technology on medical treatment we still lose a number of women and childrenn during childbirth in Tanzania. Emergency obstetric care is one of the strategies for reducing death during childbirth. Objectives: The aim of this study was to evaluate the implementation process of health system strengthening program towards improving emergency obstetric and newborn care services specifically, ability of the health facilities on providing EmONC services after health system strengthening. The goal of the project has been to improve EmONC services by ensuring availability of funds for training of health staff, procurement of medical equipment and supplies to the health facilities of Kisarawe district. Methodology: A cross-sectional descriptive study was conducted to 15 health facilities in the period of 2015-2017. The methods of data collection employed were mixed methods of data collection whereby the data was collected through face to face questionnaires to coordinators of the program, structured questionnaire administered to health staff, observation checklist and documentary review of the facilities` records. Descriptive analyses such as bar charts, histograms, line charts and percentages were employed. Results: The amount of support was not adequate since the program managed to support just four facilities out of 35. Merely 19%-20% of staff were trained for EmONC services, and almost all were from the district hospital. There was a shortage of medical equipment by 39.1-56.5% and medical supplies by 40-65% for EmONC services to all selected health facilities except the district hospital.The dispensaries and health centers could provide EmONC services at rate of 22.2-44.4% except the district hospital which had 100 percent. Conclusions: The implementation process of health system strengthening towards improving EmONC services at selected health facilities is not implemented successfully. Recommendations: There is a need of more funds, and the district should see to it that the program is implemented more effectively to realise set objectives and the Government of Tanzania should also increase its stewardship.
Evaluation of USAID – Boresha afya program contributions among healthcare facilities in Lindi district council to improvement of the supply chain management of medical supplies.
(Mzumbe University, 2019) Mwihava, Oswald
This study evaluated the contributions of USAID Boresha Afya Progam to the medicine and medical equipment supply chain management system in Lindi District Council. The evaluation specifically focused on objectives: (i) to assess the use of data quality assessment (DQA) to supply chain management; (ii) to determine the efforts of USAID Boresha Afya Program to sharpen the skills on DQA among the health providers in the served facilities; and (iii) to establish the supervision of USAID Boresha Afya Program enhances supply chain management in healthcare facilities. The evaluation employed case study design with the qualitative approach. The sample size for the study was 33 participants purposively selected. Structured interviews were used to gather data from the participants who were 30 health workers in the selected health facilities and 3 officials of the Program. Because of qualitative nature of data, analysis of the findings employed the framework analysis that involved five stages of familiarization, thematic framework identification, indexing, charting and mapping and interpretation. The findings of the study revealed that the health facilities received Data Quality Assessment (DQA) for data cleaning and verification. It was found that DQA was effective for producing clean and verified data. The health personnel were well trained to handle and manage data for supply chain management of medicine and medical supply. The findings also showed that the health facilities needed supportive supervision from the Program officials. The Program officials offered the supervision but there was no auditing service of the Program. The evaluation reached a conclusion that Programs need clean and verified data to facilitate supply chain management without which it is impossible. Moreover, skills and knowledge are very important aspects in making the Program successful. Further, the most successful Program is that which is supportive supervision is in place. It was recommended that the Program management should establish auditing unit so as to avoid malicious behavior of some stakeholders in the Program.
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.
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.
Formative evaluation for births and deaths registration at the community, Kilosa District
(MZUMBBE UNIVERSITY, 2016) Kimbute, Omari Abdallah
Background: Registration of births and deaths is vital for the proper planning and development of the country but the global and local records show that there is more than 40 million births and deaths that goes unrecorded worldwide. Methodology: Formative evaluation using qualitative research methods was applied to try to establish why the registration is low in Tanzania, the country with centralized government structure and that enjoyed peace for most of the time. Eleven key informant interviews (n=11) and three focus group discussions (n=28) were conducted in three villages that were purposely sampled. Findings: People with birth certificates were very few regardless of being provided with notification and the reason for not having certificates ranged from low level of knowledge on importance, distance to the registration office and costs associated with registration. Death registration was found to be nonexistent at the community and few registered were those affiliated to legal/police issues and of deceased who left wealth. Overall accountability for the Village Executive Officers (VEO) to the Registration Insolvency Trusteeship Agency (RITA) office was totally missing as the evaluation villages had not registered any births or deaths for years and no one asked or made a follow up. Conclusion: The overall awareness on the importance of registration of births and deaths was low not only to the community but even to those assigned to conduct this work. The state agency (RITA) needs to conduct continuous sensitization especially at the communities and bring the services closer to people. The government and other stakeholders are missing important data for planning. vi vii
Implementation process of maternal health project on emergency obstetric care and neonatal services in rural settings a case of Uvinza District council- Kigoma
(Mzumbe University, 2016) Steven Kimambo Haika
Background: Emergency obstetric care is one of the strategies for reducing maternal mortality, as pregnancy-related complications are unpredictable. However, maternal death due to problems related to unimproved comprehensive obstetric has been documented. Objectives: This evaluation aimed to assess the implementation process more specifically on the community awareness with regard to emergency obstetric and neonatal care (EmONC).The goal of the project has been to improve maternal and child health age in a population by ensuring the provision of quality health services through the utilisation of EmONC services by the community of Uvinza District Council. Methods: The study was conducted in four villages of Uvinza district in the Kigoma region. A cross-sectional descriptive study was conducted involving 120 respondents. Semi structured questionnaire was used to capture information related to implementation process of World Lung Foundation. The focus was on collecting information on several issues, such as assessing the level of community awareness in accessing EmONC services, identifying the roles of traditional birth attendants and challenges encounter by health care workers in facilities providing EmONC services. The evaluator randomly selected the participants to be included in the study. Results: The evaluation revealed institutional deliveries increased by 87.5% at CEmONC health centers, and 70% deliveries by caesarean section, the highest ever recorded. The level of community awareness in accessing EmONC services was high among the evaluation participants. Majority (87.5%) of the health care workers had received training supported by World lung foundation. The findings also revealed that traditional birth attendants have been undertaking early referrals of pregnant women to health facilities providing EmONC. vi Conclusion: The issue of 3 Ds (Delay in decisions making when to seek care, Decision of earlier referral and Decision on what time to start treatment) all these cut across as limitations to achieve millennium development goal number 5. Findings revealed that the maternal mortality rate (MMR) in all facilities decreased by 44% between January 2011 and June 2013(WLF report, 2013). Furthermore, there was a 70% increase in institutional deliveries in Project-supported facilities compared to a 30% decrease in non-Project-supported facilities; there were increased awareness of community in accessing care to health facilities providing EmONC services.
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.