Health System Management Monitoring & Evaluation(HSME)
Permanent URI for this communityhttp://192.168.30.20:4000/handle/123456789/184
Browse
74 results
Search Results
Item Assessment of the quality of postnatal care services: A case study of Mbeya District Council(Mzumbe University, 2015) Lotto, Theopista, DavidBackground: Postnatal care services consists of care given to the mother and her new- born for the first six weeks following birth, which enable health care providers identify post delivery problems and provide treatments promptly. This evaluation was conducted to assess the quality of postnatal care services following the unpublished report from Health Management Information System of the District which showed an increase in the number of maternal and infant death within six weeks post delivery. Methods: The evaluation used descriptive cross sectional study design in which quantitative approach was employed to collect and analyze evaluation data. The study was also guided by Donabedian conceptual framework based on structural and process components. A total of 355 clients attending postnatal care services in five selected facilities participated in an exit interview. Observational checklist adopted from the WHO implementation guideline was used for assessing resource availability. Data was analyzed using STATA version 13.0. Results: The findings established that health facilities that were involved in the study had basic resources to render quality postnatal care, however, there were some deficiencies in both structure and process components for provision of Post Natal Care (PNC) services. None of the five facilities had separate PNC room equipped with facilities for provision of quality services. Discussion and policy implications: The evaluated health facilities scored below 90%, based on agreed standard as set by World Health Organization which implies PNC services offered was sub-standard. Mbalizi Hospital and Inyala Health Centre had the average score of 77%, Santilya dispensary scored the third (75%) followed by Ilembo Health Centre 70% and the last was Igoma dispensary which scored 68% which is equal to partial quality. There is a need for the management of Mbeya District Council to plan for improvement of health facility infrastructures by constructing separate rooms for PNC to be able to provide quality health services and reduce neonatal and maternal death and ensure privacy to patients and clients.Item Process evaluation on the implementation of mwanzo bora nutrition program on the reduction of childhood stunting: A case of Kilolo District in Tanzania(Mzumbe University, 2018) Chisanga, Helen, JNutritional status of children is an important ending measure of their health status. Thus, child care and feeding practices has been recommended as a major solution to improve under-five survivals and promote healthy growth and development. This evaluation aimed to assess the implementation process of Mwanzo Bora Nutrition Program (MBNP) in reduction of childhood stunting at Kilolo district council in Iringa, Tanzania. The evaluation employed formative approach guided by a cross-sectional design. The evaluation enrolled a total sample size of 161 respondents. The sample included mothers of children/caregivers between 0-23 months enrolled in MBNP, community health workers and CHMT officials who were purposely and randomly selected. Data were obtained by using questionnaires, interviews and focus group discussions. Quantitative data were entered and analyzed by using SPSS software version 20 whilst simultaneously qualitative data were analyzed manually. Data were collected by using structured questionnaire, focus group discussion and in depth interview. Descriptive statistics were carried out, Chi – test was done to determine relationship between variables by using IBM SPSS version 20. The results revealed that 98% of mothers had knowledge about infant and young child feeding. There was no significance difference between knowledge of infant and young child feeding and practices especially on complementary food practice and breast feeding. However, significance difference was reported on the initiation of breastfeeding at (p≤0.05). Likewise, there was significance difference (p≤0.05) between knowledge of Mwanzo Bora Nutrition Program and its practices. Finally majority of the respondents (80%) had reported to have hand-washing equipment's; and among them 51% reported to have started using the equipment's after implementation of the program. The study concludes that use of hand-washing facilities improve hygienic condition and ultimately results on the reduction of childhood illness. Challenges associated with insufficient funds, shortage of human resources and poor community participation to some extent limited the implementation processItem Evaluation of sanitation facilities in relation to communicable diseases in government primary schools in Mkinga District Council(Mzumbe University, 2018) Mosha, Irene VBackground: Water, Sanitation and Hygiene related diseases remain one of the most significant child health problems worldwide. Infections such as cholera, malaria, trachoma, bilharzias and diarrhoea are on increase in our communities. The most affected ones are children. These diseases not only affect children‟s physical development but also school attendance and academic performance. The challenges of School Water, Sanitation and Hygiene (SWASH) are more pronounced in developing countries unlike the developed world. This study evaluated the Sanitation facilities in government Primary Schools in Mkinga district council. Methodology: The study used cross sectional study design, drawing a sample of 285 respondents. Purposive sampling was used to select Key informants. Simple random sampling was used to select Ward Development Committee (WDC), Village Government members, members of school committee, and teachers and snowball sampling was used to select Pupils, Parents/community and Private sector, Local artisans and construction companies. Primary data were collected through questionnaire and direct observation. Content analysis method was used to analyse the data from in-depth interviews. Questionnaire data were analysed using SPSS computer software where descriptive statistics such as frequencies and percentages were deployed. Results: A total number of 30% of Mkinga public primary school have sanitation facilities. Pupils whom practice hygiene are 30% but not all pupils are provided with protective gears. Community members agreed that the hygienity of water sources was poor are 36%. Conclusion: The sanitation facilities are insufficient in government primary schools. Pupils practice hygiene but not all pupils are provided with protective gears. The hygiene practice among community members is very poor due to the farming activities, which are conducted near the sources of water. Recommendations: The Government should ensure that, the district level guidance and support for compliance reflects the National regulatory framework. Use appropriate guidelines where standards do not exist.Item 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 RwechunguraThis 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.Item 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 StevenBackground: 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.Item Assessing factors influencing reporting of weekly diseases data from regions to ministry of health and social welfare in Tanzania Mainland(Mzumbe University, 2015) Moshi, Solomon FrankBackground: Reporting weekly diseases data from regions to Ministry of Health and Social Welfare is one of method which is used to submit weekly diseases information from regions to the Ministry according to number of weeks in a year from 1st to 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 levelsItem Effects of exemptions on cost sharing practices in government health facilities: A case study Chunya District Council(Mzumbe University, 2015) Chengula, Veronica ,Andreas.The study looks into the effects of exemptions on cost sharing practices at Chunya district hospital. The research objectives were to determine the awareness of health service providers on exemption mechanisms, how exemptions are implemented and satisfy the eligible groups, what are the effects of exemptions and identifying appropriate mechanisms of improving the implementation of exemptions. The study adopted a case study design by using questionnaires and interviews for primary data collection while secondary data were obtained from reviewed relate documents. The study was completed by 60 respondents working in different departments of Chunya district hospital including CHMT. Moreover, the sampling techniques were both non-probability and probability sampling, which include purposive sampling and simple random sampling. From the findings of the study, the majority 55 (91%) were aware with exemption Mechanisms in their work place. Moreover, on the satisfaction of the groups who are exempted 35 (58%) the system is satisfying with some challenges. Furthermore, on the effects of exemptions on cost sharing the result showed that 56 (93%) of respondents agreed that exemptions has effects of cost sharing due to lower revenue collections, workforce crisis and inadequate medicine and medical supplies. Tanzania should implement cost sharing and exemption mechanisms in situations that can maximize the revenue collection, compensate the revenue lost in exemption by using tax collected from natural resources i.e. gold mining, tourism, gas and mobilization of CHF.Item Factors towards low contraceptive uptake: does providers’ capacity matter : A case in Morogoro District Council(Mzumbe University, 2015) Stephen J. MdumaThe 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.Item 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 providedItem 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.