Health System Management Monitoring & Evaluation(HSME)

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    Factors and challenges associated with loss of follow up visits among HIV/AIDS clients attending antiretroviral therapy in Ilala municipal council
    (Mzumbe University, 2015) Salema, Judith
    Background: The loss of follow up visits among HIV positive adults on antiretroviral therapy is a leading cause of morbidity and mortality in Tanzania. The loss of follow up visits brings a big challenge in Care and Treatment Centre (CTC) as many HIV clients are not attending clinics as scheduled. Broad Objective: To assess the factors and challenges associated with the loss of follow up visits among HIV positive adults attending CTC in Ilala Municipal Council. Methods: Cross sectional study design was conducted in Ilala Municipal Council involving HIV positive adults and health providers whereby data were extracted from CTC database and clients’ files. Data were obtained through structured questionnaires and were entered into Microsoft Excel and analyzed by using Stata version 13. Analysis for predictors was done using univariate and multivariate logistic regression where p value of <0.05 was considered as statistically significant. Results: 240 people were recruited in the study. 190 were patients, 50 were health workers, and most of the patients were females with the age ranging from 18-35 years amounting to 102 (54%). Lack of fare 72(60%), Stigma, shift from one clinic to another and use of traditional medicine found to be the factors contributing to the loss of follow up visits. However, lack of space (92%), shortage of health providers (94%), stigma and discrimination (90%), low motivation (94%) and work load (94%) were the challenges facing health providers during provision of services to HIV patients. Conclusion and Recommendations: The study found that the recording system of the patients’ information were poor, there were some clients who died, others were shifted to other clinics but the CTC term them as the loss of follow up visits therefore the data recording system should be strengthened.
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    Does health insurance contribute to improving responsiveness of the health system?: The case of elderly in rural Tanzania
    (Umeå University, 2022) Amani, Paul Joseph
    Background: Financing healthcare in Tanzania has for years depended on out-of-pocket payments. This mechanism has been criticized as being inefficient, contributing to inequity and high cost as well as denying access to healthcare to those most in need, including the elderly in rural areas. Health insurance (HI) was recently introduced as an instrument to enable equitable access to healthcare and thus to improve the responsiveness of the health system. Even though health insurance is expected to bring benefits to those who are insured, there is a lack of specific studies in the country looking at the role of HI in facilitating the health system responsiveness among vulnerable populations of remote areas. Aim: The aim of this thesis is to understand if and how health insurance contributes to improving the responsiveness of the healthcare system among the elderly in rural Tanzania. Methods: Four interrelated sub-studies (2 quantitative and 2 qualitative) were conducted in Igunga and Nzega districts of Tabora region between July 2017 and December 2018. The first two sub-studies are based on a household survey using an adapted version of the World Health Organization’s Study on Global Ageing and Adult Health questionnaire. Elderly people aged 60 years and above who had used both outpatient and inpatient healthcare three and twelve months prior to the study, respectively, were interviewed. Whereas in sub-study 1 the focus was to investigate the role of health insurance status on facilitating access to healthcare, sub-study 2 assessed the relationship between health insurance and the health system responsiveness domains. In sub-study 3, interviews with healthcare providers were carried out to capture their perspective regarding the functioning of the health insurance. In the final sub-study 4, focus group discussions with elderly were conducted in order to explore their experience of healthcare, depending on their health insurance status. Crude and adjusted logistic and quantile regression models were applied to analyse the association between health insurance and access to healthcare (sub-study 1) and responsiveness (sub-study 2), respectively. For both sub-studies 3 and 4, qualitative content analysis was used to analyse the data. Results: Sub-studies 1 and 2 involved a total of 1899 insured and uninsured elderly, while sub-studies 3 and 4 included 8 health providers and 78 elderlies respectively. Sub-study 1 showed that about 45% of the elderly were insured and HI ownership improved access and utilization of healthcare, both outpatient and inpatient services. In sub-study two, however, health insurance was associated with a lower responsiveness of the healthcare system. In general, all six domains: cleanliness, access, confidentiality, autonomy, communication, and prompt attention were rated high, but three were of concern: waiting time; cleanliness; and communication. Sub-study 3 uncovered several challenges coexisting alongside the provision of insurance benefits and thus contributing to a lower responsiveness. These included shortage of human resources and medical supplies, as well as operational issues related to delays in funding reimbursement. In sub-study 4, the elderly revealed that HI did not meet their expectations, it failed to promote equitable access, provided limited-service benefits and restricted use of services within residential areas. Conclusion: While HI seems to increase the access to and use of healthcare services by the elderly in rural Tanzania, a lower responsiveness by the healthcare system among the insured elderly was reported. Long waiting times, limited-service benefits, restricted use of services within schemes, lack of health workforce in both numbers and skills as well as shortage of medical supplies were important explanations for the lower responsiveness. The results of this thesis, while supporting the national aim of expanding HI in rural areas, also exposed several weaknesses that require immediate attention. There is a need to, first, review the insurance policy to improve its implementation, expand the scope of services coverage, and where possible, to introduce cross-subsidization between the publicly owned schemes; additionally, improvements in the healthcare infrastructure, increasing the number of qualified health workforce and the availability of essential medicines and laboratory services, especially at the primary healthcare facilities, should be prioritized and further investments allocated.
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    Governing climate change adaptation in urban Tanzania
    (2026-06-05) Mushi, Lawrencia; Ogweyo, Noel O.; Cosmas, Faraja U.
    Climate change is one of the greatest global health threats of the twenty-first century, with profound implications for health systems and progress toward universal health coverage. In Tanzania, urban areas such as Dar es Salaam are increasingly experiencing climate-related health challenges, including flooding, heat stress, and outbreaks of climate-sensitive diseases such as cholera, malaria, and respiratory infections, placing growing pressure on already constrained urban health systems. Although urban health systems in low- and middle-income countries are increasingly exposed to these risks, evidence on their capacity to govern and implement climate change adaptation actions remains limited. This study aimed to explore the governance capacity of the urban health system for climate change adaptation in Dar es Salaam, Tanzania. An exploratory qualitative study was conducted using in-depth interviews (IDIs) and focus group discussions (FGDs) with key stakeholders involved in health governance, policy development, and health service delivery. A total of 68 participants were purposively selected from municipal health management teams, public health facilities, and academic institutions across four municipal councils in Dar es Salaam. Data were analysed thematically and organised using ATLAS.ti software. The findings revealed strengths and gaps across three key areas of climate change adaptation governance. First, early warning and preparedness mechanisms existed but were constrained by fragmented disease surveillance systems, weak emergency response team functionality, and inadequate climate–health data for decision-making. Second, human resource capacity was supported by available training and research institutions; however, staffing shortages, limited training coverage, and irregular refresher training reduced preparedness for climate-related health emergencies. Third, institutional and material capacity remained inadequate, characterized by limited operational climate change guidelines at the facility level, infrastructure gaps, and insufficient financial and material resources to support effective adaptation. Although municipal health systems in urban Tanzania have initiated climate change adaptation efforts, the governance of these actions remains constrained by uneven and inadequate institutional capacity. Persistent shortages in human resources, infrastructure, and sustainable financing undermine the effectiveness of early warning systems and preparedness mechanisms. Consequently, urban health systems remain insufficiently resilient to complex climate-related health risks. Therefore, strengthening climate-resilient health governance will require targeted investments in workforce capacity, infrastructure, integrated climate-health information systems, sustained financing, and clearer institutional guidelines to support proactive and coordinated adaptation across governance levels.
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    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.
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    Outcome evaluation of micro credit scheme saving and internal lending community intervention from people living with human immunodeficiency virus in Magu district
    (Mzumbe University, 2019) Iriya, Lucy C
    Background and rationale: HIV/AIDS has caused negative impacts on livelihoods including socio-economic problem, food insecurity and increased number of orphans in Sub-Saharan countries, including Tanzania. Following this, TAZAMA, the project operated under the Tanzania National Institute for Medical Research (NIMR) initiated the so called Microfinance schemes with the main objective to mitigate the negative impact of HIV/AIDS among People Living with Human Immunodeficiency Virus (PLHIV) and vulnerable populations in rural areas. Therefore the purpose of this study was to evaluate the contribution of microfinance Saving Internal Lending Community (SILC) intervention under TAZAMA project to the living standard of People Living with Human Immunodeficiency Virus (PLHIV) in Kisesa, Bujora and Bukandwe in Magu district within Mwanza city Tanzania Methods: Analytical cross-section study design was used which adapted mixed research methods; both quantitative and qualitative approaches were used. About 119 participants aged 18years old and above, PLHIV and beneficiaries of the SILC programme in Magu District suburb of Kisesa, Bujora and Bukandwe wards were enrolled for the study. Both self-administered questionnaires and interviews were used for data collection. STATA Statistical Software Package and ATLAS.ti V. 7 were used for data analysis. Inferential t-test and chi-squire test were used; also descriptive statistics such as frequency and percentage were presented in form of tables, figures and graphs. Results: The findings revealed that the majority of PLHIV had manage to save and receive credit through SILC groups, all beneficiaries of PLHIV manage to start entrepreneur activities after joining SILC groups such as horticulture, shops, transportation (bodaboda) and tailoring. Also, the findings show SILC members were able to increase meal intake and increased food stock. About success of SILC programme results shows PLHIV in improving their Living standard by owning assets and business. Statistically, there is significance difference on Ox-plough farm equipment before loan and after loan at P-value of 0.0095<0.05 which shows there is improvement in farming activities due to program intervention. Moreover, there is significance difference in type of wall materials used among the household of PLHIV before and after loan at P-value of 0.000<0.005. Conclusion: The scheme has been positively impacted to PLHIV through operational SILC groups by saving and receiving microcredit. It had improved lives of the PLHIV in the three wards in Magu district and therefore, the Government and other stakeholders should allocate resources to scale-up SILC initiatives to other areas of Magu District and beyond to cover unmet needs of PLHIV since the project did not cover the entire community of people who are living with HIV/AIDS.
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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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    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.
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    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 J
    Nutritional 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 purposively 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 equipments; and among them 51% reported to have started using the equipments 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 process.
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    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.