Dissertations (Masters)-HME-SOPAM
Permanent URI for this collectionhttps://scholar.mzumbe.ac.tz/handle/123456789/1533
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Item 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.Item Process evaluation of result based financing program on improving maternal health in Kishapu District Council, Shinyanga Region(Mzumbe University, 2019) Ngwale, Tedson J.Shinyanga region is one among the regions of Tanzania mainland with high maternal mortality rate (MMR). In 2015, it was reported to have 60 MMR and ranked number one due to unsatisfactory health condition and poverty index. Result Based Financing (RBF) was introduced in Tanzania particularly in the regions with high burden of diseases with the aim of achieving Universal Health Coverage goal and to offset the long-term health sector challenges. RBF was implemented in Shinyanga from 2015. It was initially implemented in 157 health facilities where in Kishapu District Council (DC) is implemented to 55. Since the implementation of RBF in Shinyanga, there are limited studies conducted to evaluate its progress. Thus, the study aimed to conduct a process evaluation study on improvement made by RBF program on maternal health services in Kishapu District Council. Specifically, the study ascertain the extent to which maternal health have been improved at health facilities due to RBF implementation; to examine whether maternal health services delivery and support functions consistent with RBF system; also, to examine healthcare provider’s perceptions on bonus payment for RBF implementation towards improving maternal health services. The study employed a descriptive cross- sectional design with a mixed method approach. A semi-structured questionnaire was used to collect data from randomly selected 147 respondents from all 55 health facilities. Quantitative data was analysed by the use of SPSS V. 25.0 and descriptively presented by tables, figures, and measure of central tendency. Qualitative data was analysed with the help of ATLAS ti version 8.2.4 programs for content analysis. The results reveal that, (82.3%) of the health professionals provided appropriate healthcare to women with delay in labour as per national health guidelines, (80.3%) provided routine postnatal care to mothers and their new-borns, whereas all interviewed health professional (100%) provided care to women and new-borns as per standard precautions for preventing hospital-acquired infections. Nevertheless, (81.65%) of health professionals did not carry out an exit interview with their clients to gather important information about the quality of maternal health services.