Dissertations (Masters)-HSM-SOPAM

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    Process evaluation of adolescent and Youth Sexual Reproductive Health (AYSRH) programme on utilization of sexual and reproductive health services: A case study of Kinondoni Municipality.
    (Mzumbe University, 2019) Muhoja, Winfrida L.
    Different stakeholders have been investing in the adolescent and youth programme to help them by providing sexual reproductive health services including the challenge initiative (TCI) on Tupange Pamoja under Jhpiego in Dar es Salaam. It was believed that Adolescent and Youth Sexual Reproductive Health (AYSRH) services would contribute to the rise of Contraceptive Prevalence Rate (CPR). Study conducted in Kinondoni Municipality which showed significant rise of CPR from 11% in 2017 to 13.5% in 2018 after implementation of Tupange Pamoja and AYSRH programs. The objectives of this study were to examine how AYSRH program was implemented, what were the factors facilitated and impinging attainment of outcomes and what were the best practices on attainment of program outcomes. The study adopted a case study design. Health managers were purposively selected based on involvement in designing, planning and implementing programme. Convenient sampling selected on duty trained health care providers (HCP), and young people attended services, made total of 19 respondents. Data were collected through documentary review (Reports and guidelines), in-depth interviews to health managers, HCPs and young people, observations in health facilities. Analyses of interviews were conducted by importing transcriptions in ATLAS ti. 7 by coding themes as per objectives, thus, output report generated for report writing. Content analysis conducted for documentary review. Results indicated that, process involved municipal council on designing, planning and implementing programme with technical support from jhpiego organization. Commitment of budgeting for services and supplies of AYSRH and capacity building were major factors for the improving utilization of young people services. Major factors impinge the attainment of outcomes were bureaucracy, late report submission and unavailability of condoms. Best practices were program design at council level, community dialogues, data management and services sign boards. Major conclusion was that, implementation of demand generation, advocacy, services and supplies increased number of young people using SRH services. Municipal medical officer’s office should train more providers, to make sure health facilities budget for audio and visual materials, recognize peer educators’ role and manage to have enough stock of supplies and commodities especially condoms. MoHCDEC should provide guidelines addressing both adolescent and youth issues.
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    Process evaluation of temporary exemption implementation for emergency cases in St. Augustine Muheza designated district hospital
    (Mzumbe University, 2019) Msabaha, Rasmo
    This study was set to evaluate temporary exemption implementation for emergency cases at St. Augustine Muheza designated district hospital. A temporary exemption is the process in which patients who have no money for covering health services at the point of service delivery, after being assessed by a social welfare officer, have a chance of receiving services under loan agreement so that such money to be settled on later. The main purpose is to ensure accessibility to health services regardless of the ability to pay. The general objective of the study was to evaluate temporary exemption implementation for eligible emergency cases and its effect on sustainability in revenue collection. The study was meant to answer the following research questions: How is the guideline for cost-sharing policy in the area of temporary exemption to emergency cases are being implemented at St. Augustine Muheza designated district hospital?; How the follow-ups of un-paid bills from patients who received temporary exemptions are being conducted?; How verification of payments which have done by clients who were given temporary exemptions, and are already at their homes are conducted? and; What are the factors facilitating or impinging the payment of bills by temporarily exempted patients at St. Augustine Muheza hospital? The study applied a descriptive cross-sectional design, in which participants were selected through purposive and convenient sampling techniques. Documentary review, in-depth interviews and focus group discussions were used for data collection. A total of 34 respondents participated in the study whereby 8 health workers involved in one FGD, and the rest 26 (both health workers and community members) participated in the in-depth interviews. The content analysis method was used to analyse data from field. The overall results revealed that about 2% of the total patients admitted at St. Augustine Muheza designated District hospital per year received temporary exemptions, and for three consecutive years only 3.5 out of 94.6 million were paid as temporary exemption bills. The low payment of bills was due to the lack of follow up strategies at the hospital, absence of social welfare department and lack of community sensitization. This study documented that, St. Augustine Muheza designated district hospital have no mechanisms for bills payment, lack of social welfare officers, and lack of community sensitization are some of the factors influencing the low payment of bills that led the hospital to operate under budgets.
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    Evaluation of longterm methods family planning training to skilled health care provider to reach the national target: A case of Mufindi District.
    (Mzumbe University, 2019) Balama, Elizabeth
    Introduction; The government through its councils wants to put an emphasis on training health care providers on family planning in the implementation of family planning program. The main objective of this study is to assess the training on long term methods of family planning to skilled health care provider to reach the family planning National target. Methodology; The study included 10 health facilities (1 private hospital, 3 public Health Centers and 6 public Dispensaries). In-depth Interviews (IDIs) were conducted to all 10 RCH in charges from 10 facilities and 1 Focus Group Discussion were conducted to 6 members from Council Health Management Team (CHMT) who were DRCHCo, DHS, DHIS2 Coordinator, BRN coordinator DNO and CBHCo. A cross sectional design was used in evaluating this program using purposive sampling methods. Data was collected through Focus Group Discussions where by 6 members of CHMT were involved in FGD and in-depth interviews for Council Health Management Teams and RCH in charges. Phenomenological and narrative analysis was used to explore individual and group experience with the help of Atlas.ti software. Findings; The findings show that family planning is conducted as it planned and the family planning health care providers are trained on the provision of long term methods of family planning methods. But there are inadequate documentations for the training conducted on who have been trained, what methods were used, where the training was conducted and who funded it. Also training on long acting methods of family planning is offered through the MoHCDGEC and Boresha Afya with full package according to the family planning teaching module. Conclusion; The provision of long term methods of family planning training to skilled health care providers is of great impact on the process of reaching the National target. Follow up should be done to those who are trained and proper documentation should be made. Key words: Evaluation; long term; family planning; skilled health care providers
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    Evaluation of implementation process of Star Rating Assessment and quality improvement plans in primary healthcare facilities in Tanzania : A case of Kibaha Town and Rufiji District councils.
    (Mzumbe University, 2019) Justine, Chrisogone
    The Government of Tanzania through Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) introduced the Star Rating Assessment (SRA) system as initiative under Big Results Now (BRN) to assess the quality of health services. The SRA system used standardized tools for assessing the quality of health services and the star level ranges from 0-5 stars depending on the quality of services provided. The SRA had a target of 80% of Primary Health Care (PHC) facilities be rated 3 stars and above by June 2018 but unfortunately only 20% of facilities attained this target countrywide. The study aimed at assessing the implementation process of SRA and Quality Improvement Plans (QIPs) as one of the initiatives in improving the quality of healthcare delivery in primary health facilities in Kibaha TC and Rufiji DC. I adopted a descriptive cross-sectional study design whereby qualitative technique was employed to gain the experiences of individual healthcare providers and groups of Quality Improvement Teams (QITs) on implementation of SRA. Data was collected through Focus Group Discussions (FGDs) in which 4 FGDs were conducted comprising between 4-7 participants for QITs and in-depth interviews (with 19 participants) for facility in-charges, CHMTs (DMO or District Health Secretary), Council and Regional QI Focal Person, and SRA coordinators at national level (MoHCDGEC and PO-RALG). Data were analyzed using qualitative content analysis, which offers the development of categories from the text data inductively in capturing experiences from the key informants. The study findings revealed mixed results regarding implementation of SRA and QIPs in PHC facilities. The results showed that the awareness on SRA system was low among healthcare providers, the QIT members were not aware of their roles in implementation of QIPs and the CHMTs were not including QIP follow up progress as part of their quarterly supportive supervision. Some of the reported challenges that were encountered during implementation of SRA and QIP included but not limited to shortage of staff, financial resources, inadequate training of staff on SRA system, and inadequate CHMTs support through supportive supervision. The implementation of SRA has shown some improvement in the delivery of quality healthcare in the study sites. However, enhancing the proper implementation of SRA especially QIP follow up and overcoming the barriers to implementation will improve the quality healthcare in Tanzania. MoHCDGEC, PO-RALG, R/CHMTs, Facility in Charges and QITs should play their roles for effective implementation of SRA system in Tanzania.
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    Assessment of longterm contraceptive utilization among women of reproductive age : A case of Kibaha town council
    (Mzumbe University, 2019) Yusuph, Phidman
    Family planning is important in the community as it gives an opportunity for the individual to make decision on the number of children they wish to have, but also it prevent unintended pregnancy which lead to abortion especially unsafe abortion. For those women who are using family planning they have a chance to restore their health wellbeing. Economically it’s also benefiting the couple as they can make plans of their life depending with the number of children they have or they wish to have. The study approach was sequential mixed study which involved both quantitative and qualitative. The sample size quantitatively was determined by using Yamane formula and the sample size obtained was 396. On the other part of qualitative, the data were collected until saturation from key informants. Quantitative data were analysed by assistance of Stata and that the descriptive statistics finding were presented in percentage, charts and tables. Logistic regression used in analysis so as to give out inferential statistics findings, The qualitative data were analysed with the assistance of Atlas ti ,according to the views from the key informant’s especially health care providers and DRCHCO, they said education level and living in urban makes women to be aware on LARC services as also they proved that myths and misconceptions on the LARC, religious, availability of the services and husband decision on FP use have been obstacles for the women to use Long Acting Reversible Contraceptive methods. The study recommends efforts from different stakeholders and the Government to put much emphasis on ensuring that the health education on family planning especially LARC is reaching the community and male involvement it’s also a key Knowledge and awareness is the source of women and the community in large to change their behavior towards the use of long acting Contraceptive methods and avoid them from unwanted pregnancy which could lead to unsafe abortion and death. Key words: Long Term Contraceptive; Utilization; reproductive age; Kibaha
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    The effect of awareness raising and accessibility modifications on the use of family planning and HIV services among youth and women with disabilities in Oromia Region, Ethiopia
    (Mzumbe University, 2019) Negussu, Metassebia
    The study aimed to assess the outcome of a project implemented with the purpose of improving Family Planning/Reproductive Health (FP/RH) service access and utilization among youth and women with disabilities targeting Jimma and Agaro towns as a research site. Accordingly, the researcher assessed the effect of awareness raising and accessibility modification efforts of the project on utilization of FP and HIV service among the targeted group via adopting the theory of planned behavior as the conceptual framework. Post intervention quasi-experimental design was employed to conduct the study. In view of this, a Sample of 295 youth and women with disabilities was drawn, of which 183 of the intervention and 112 of the control group respondents took part in the quantitative study. On top of this 6 intervention group respondents, 4 service providers and 2 Associations of Organizations of Persons with Disabilities (DPO) chair persons participated in the qualitative data collection method. Additionally, the two research towns were purposively selected initially, followed by stratified and simple random sampling methods to select study respondents. Moreover, mixed methods of data collection was used to collect data, particularly a questionnaire, checklists, interview guide and unstructured observation were used. The organized awareness raising campaigns on average possessed 69% elements of a successful awareness raising campaigns. On top of this, findings of the study revealed that FP and HIV service awareness and use among the project beneficiary was comparatively higher vis-a-vise the control and baseline group respondents, despite the infrastructures’ inaccessibility and communication challenges. Furthermore, findings indicated that attitude, subjective norm and behavioral control have statistically and substantively significant relationship. Moreover, findings designated that intention of intervention group respondents predict FP services utilization. Finally, facilitation of a continuous joint follow-up visits involving key stakeholders to assess service accessibility and to take a timely corrective measure at the health facilities level recommended to address the observed gap. Key words: Awareness raising; accessibility modifications; use of family planning and HIV; youth and women with disabilities; Oromia; Ethiopia
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    Evaluation of result based financing program at primary healthcare facilities ; Data quality improvement in health management information system: A case of Mafia District council
    (Mzumbe University, 2019) Nahoda, Hassan
    The study evaluated result based financing program at primary healthcare facilities, Specifically, it intended to examine the RBF HMIS training on data quality improvement in HMIS at Primary healthcare facilities, examine the extent by which RBF data sharing meeting on data quality improvement in HMIS at Primary healthcare facilities, and evaluate the RBF supportive supervision on data quality improvement in HMIS at Primary healthcare facilities in Mafia DC A descriptive cross-sectional evaluation design was employed and a mixed method was used where simple random sampling techniques were used to select health care workers from RBF facilities. The self-administered questionnaire was employed and purposively technique was used to select key informants from RBF facilities to participate in an in-depth interview. Quality of health management information systems for managing patients and managerial issues was poor 38.4% in 2017 due to poor knowledge of health workers towards data collects, processing, analyzing and use for further improvement of health services provision. Obviously, this has a profound effect on service quality, customers’ satisfaction, health facilities’ performance and profitability, increasing morbidity, disability, and death, which also affects stability and economic activities of a country. The findings revealed that the majority of respondents attended training on HMIS data, it’s about 89.9% of them. When supportive supervision on HMIS data towards the quality of HMIS data was assessed, many showed to have contributed to data quality on HMIS data. Moreover, the researcher found data sharing meeting for health staff attended at least in on time which was noted to have great contribution to the improvement of the quality of HMIS data in their facility. The study noted that RBF program has increased health providers’ capacity to collects, analyze and use data in promote quality of health services provision. The health workers acquired knowledge and skills on collecting, analyzing, presenting, and using data. However, health care workers claimed that sometimes due to excessive workload they did not have enough time for data collecting and submitted timely to CHMT. The study concluded that RBF program has increased the improvement of data quality in health management information systems. The RBF program increased knowledge of healthcare workers in perspective of data collections, analysis and use at Primary healthcare facilities in Mafia DC. The study recommended that more initiatives should be carried out by the government and other stakeholders to advocate on improvement of data quality in HMIS to other districts and regions that are not implementing RBF program. This willpower progressively changes the outlook of health staff towards data collection, analysis, and use in decision making. Key words: Evaluation; Result-Based Financing; Data Quality Improvement.
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    People’s perception on mosquito net performance: A cross-sectional study in North-Western part of Lake Zone in Tanzania, Muleba District
    (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 not having enough nets and bed nets being too old or in 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 wear and tear, 5 nets survived out of 10 nets after 3 years and 4 nets sustained field conditions 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 associate 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 differences, 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.
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    Patients’ satisfaction under National Health Insurance Fund (NHIF): The case of Bugando Referral hospital
    (Mzumbe University, 2015) Mtwe, Joseph Nyamhanga
    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.
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    Factors contributing to teenage pregnancies in Tunduru District Council
    (Mzumbe University, 2015) Malisa, Judith Nsimbo
    This study was an attempt to assess the factors contributing to teenage pregnancy in Tunduru District Council. The objectives of the study were to determine whether poverty, awareness and low access to family planning services, peer pressure, and level of education contributed to the problem also to solicit for suggestions on how to curb them. Cross sectional research design was used to show and also help in investigating associations between risk factors and the outcome of interest. Purposive sampling technique was used because it enabled the researcher to include only the respondents that were needed for the study. The target population consisted of 183 respondents who satisfied the inclusion criteria. Primary data were collected from the respondents using self-administered questionnaires via the reproductive health service providers. Validity and reliability issues were considered in order to ensure consistency of the data. Both qualitative and quantitative methods of data analysis were used to analyze data in order to minimize the weakness of one another and thereafter SPSS program version 20 was used to code them. The results revealed that poverty, peer pressure, level of education, poor knowledge on the use of family planning contraceptives, reproductive health, little access of family planning methods, early marriages and low access to family services contributed much to the problem. Pregnancy prevention strategies were recommended based on the results. The strategies focused on improving female literacy rate, establishment of adolescent friendly clinics, revision of the current marriage law, encourage community based programmes for sensitization purposes, establishment of gender help desk specifically for youths in order to help them when in need and many others.