Health Systems Management & Evaluation(HSME)

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Cost of dialysis in Tanzania: Evidence from the provider’s perspective
(Health Economics Review, 2015) Mushi, Lawrencia; Krohn, Markus; Flessa, Steffen
Background: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. Methods: Cost calculations are based on the provider's perspective and include only the direct cost of dialysis treatment. The cost of drugs and consumables was obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interviews with experts at the dialysis unit. Results: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will incur annual costs of 27,440 US$. Conclusion: The cost of dialysis is enormous for a least-developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards curable diseases, which have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all efforts must be invested to improve technical efficiency by cutting the enormous unit cost.
Role of cultural orientation towards risk sexual behaviors among school children: A case of selected secondary schools in Morogoro Urban
(Mzumbe university, 2015) Goodluck Patrice Nombo
The study was conducted in Morogoro urban in Tanzania to explore the relationship between the cultural orientation and students risky sexual behaviors and examine whether and how modern intervention including modern contraception influence these behaviors to secondary and primary schools students. The main concern was to find out if traditional intervention through cultural orientation could be a proper strategy for risky sexual behaviors by determining the cultural orientation negative roles in students‟ sexual behaviors and also whether and how modern intervention programs for risky sexual behaviors had succeeded to reduce the problem. The study employed cross-sectional design: structured and unstructured questionnaires were used to collect both primary and secondary data. It involved 300 respondents from five secondary schools that were purposively selected while convenience sampling was used in choosing 1 education officer, 1 health officer and 3 indigenous aged people. Findings: 85% of students in secondary schools had sex before 19 years in which 68.33% of them did not use condoms completely as a result of cultural orientation factors; initiation ceremonies fostered the problem by 74.57% for males and 79.81% for females; having multiple sexual partners by 78.18% for males and 60.67% for females; Religion fostered the risky sexual behaviours by 61.42%; the orientation to use calendar or safe days method than modern contraceptives to females by 64.67%; social taboos caused 28% of males and 41.33% females not to use condoms. The parents‟ use of strokes to punish their children had led to the increase of risky behaviors among 19% of male students‟ while for females it decreased. Cultural orientation factors had impact on failure or success of the modern strategies including contraceptives on controlling risky sexual behaviours, thus there was a call for improvement of sexual health education via reviewing the cultural orientation factors in efforts to combat the
Implementation of subsidy ITNs vouchers scheme: The experience from Chunya District
(Mzumbe University, 2015) Lumuliko, Yohana N.
The study main objective was to explore the implementation of subsidy ITNs vouchers scheme, the experience from Chunya District, specific objectives was on examining malaria incidence, investigating subsidy insecticide treated nets (ITNs) vouchers coverage and identifying challenges faced by subsidy ITNs vouchers program actors and beneficiaries during the implementation. This study was descriptive cross-sectional, applied a triangulation of quantitative and qualitative methods. Information’s on malaria incidence and subsidy ITNs vouchers coverage was obtained from soft and hard copies archived records and reports by using checklist extracted from the District Medical Office. Information on challenges experienced during the implementation was obtained through an in-depth interview by involving three key participants, who were malaria focal person, community leader and selected woman rearing a child as program beneficiary were involved. Data analysis involved summarization and import in micro-soft excel for quantitative data for table and figure. For qualitative data atlas.ti was used for grounded theory and content analysis. Overall findings indicated the decline in malaria incidence as DMO‟s report depicted from 34% in 2012 to 9.2% for outpatient department (OPD) and 10% for in patient in the year 2013. Further findings revealed that, 9,380 pregnant women were identified in 2013, only 2,915 received subsidy ITNs vouchers equal to 31%. Also, findings revealed a total 5,163 of subsidy ITNs vouchers distributed to pregnant women in 2014, but a report was blank for the number of pregnant women received. Furthermore, majority of participants have knowledge about subsidy voucher. Also, findings observed that, some community members missed their share. Challenges identified were poor communication and coordination between actors. Subsidy ITNs vouchers scheme has shown to contribute in reducing malaria incidence despite some setbacks those emerged. It is necessary for the health sector management to rectify weaknesses observed for improvement during future intervention of the same nature.
Determinants of obesity among rural men aged 18 years and above: A case of Bagamoyo district hospital
(Mzumbe University, 2015) Lugendo, Pendo Eva
Introduction: In Tanzania, obesity is regarded as a town problem; but currently the problem is facing the rural community as well. However, the magnitude and determinants of this problem in rural areas are not well known. This study aimed to explore determinants of obesity among rural men aged 18 years and above in Bagamoyo district. Methodology: A cross sectional study design was employed; data were collected from selected health facilities in Bagamoyo district. A Hundred and twenty men patients aged 18 years and above who visited health facilities during the study period were recruited. A semi-structured questionnaire was used to collect primary data. Secondary data were obtained from reviewing patient’s registers and files from CTC and Diabetes clinics in Bagamoyo district hospital. Data were entered and analyzed using Microsoft Excel applications. Results: The findings showed that 41.5% and 31.7% of the obese men were of the age group 40 or above and between 29-39 years respectively. Majority of the obese men were married and cohabiting by 37% and 27% respectively. Over 70% of the obese men earned a monthly incomes ranging from TZS 201,000/= to TZS 300,000/=. Furthermore, 56% of the obese men reported to eat 3 times a day and 24% more than 3 times a day eat starch food like ugali and beans, rice and beans in as lunch and dinner while during morning they eat fried doughnuts or cassava. Beer and soda were highly preferred by obese men by 43.9% and 35% respectively while 34% had drinking habit after working hours. More than 70% of the obese men did not participate in physical activities, 56% reported that they did not have recreational places and 65.9% did not engage in any recreation clubs. In addition, the findings from CTC and Diabetes clinics revealed that overweight and obesity is an indicative of being at risk of co-morbidities. Recommendations: This study strongly recommends that education should be given on how to prevent and control obesity, for example education on eating balanced diet as well education on physical activities.
Assessment of outreach immunization services as a strategy to increase immunization coverage to reach Zanzibar national target of ninety Percent. A case study y - north “A” district of Unguja
(2015) Mize, Shah Abushir
Reaching the whole target population is one among the five essential components of the WHO/RED Strategy, and an operational approach to achieve immunization coverage. Different approaches for reaching target population enhance delivering of the health services to a large proportion of the population, that is Outreach (fixed site or mobile), Mass campaign and Village Health Day and Nutrition,The study was conducted to assess the outreach immunization service as a strategy to increase immunization coverage to reach Zanzibar national target of ninety percent. The study was carried out as quantitative and qualitative descriptive case study design involving 100 respondents including 80 community members from 5 selected Shehia in North “A “District of Unguja (Bandamaji, Kinyasini, Kandwi, Fukuchani and Kigongoni); 13 service providers from Chaani Kubwa, Kidoti and Pwani Mchangani health facilities and 7 supervisors from the District Health Management Teams. The information was obtained using guided interview questions, documentary review, and checklist/ observation. Data analysis was done by manual sorting, tallying, tabulation on master sheet through electronic software, and the results are presented in figures, tables and percentage (both qualitative and quantitative). The study findings revealed that the majority 46.15% of service providers interviewed were unskilled personnel (auxiliary worker) who execute outreach immunization services, with no reliable transport to track and follow up the outreach services, (23.75) % of the respondents agreed that outreach settings were not conducive to perform outreach services, and (16.25%) respondents were not satisfied with the services they received at the outreach setting. The study concluded that, factors limiting reaching unreached population include: weak supportive supervision (30%), weak male involvement (20%), and shortage of qualified staff (50%) to execute outreach immunization services and to reach all target population viii.Moreover, community suggested that to increase the number of resources, outreach services should be comprehensive and integrated as well as construction of health facility at every outreach setting to be put into consideration.The study recommended that the need to increase the demand for and supply of qualified staff so as to improve the utilization of health services and performance of the providers; to intensify community education on the use of the health services and to effectively provide supportive supervisions at regularly (at least monthly or quarterly) to improve staff performance.
Assessment of energy efficient rocket stoves contribution on deforestation control in Tanzania: A case study of Chamwino District in Dodoma Region
(Mzumbe university, 2015) Annamaria Cornelius Gerome
Deforestation is undeniable fact that it is a worldwide environmental concern. This study assessed contribution of energy efficient rocket stoves technology in deforestation control at household level in Chamwino District whereby it specifically examined adoption and adaptive use of energy efficient rocket stoves technology. It also explored the impact of energy efficient rocket stoves technology in rate of deforestation and identified challenges in adoption and use of energy efficient rocket stoves technology in the study area. The study involved 114 respondents including randomly selected 100 households and 14 purposely selected key informants such as WEO, VEO, DEMO, FO and STT Officers. The data were collected using structured questionnaires, interviews, focus group discussions, participant observation and documentary review. Quantitative data were analysed using descriptive statistics while qualitative data were analysed through content analysis based on emerging themes. Moreover, forest cover change was assessed using ERDAS IMAGINE 2014, ArcGIS 10.2.2, Google Earth and Microsoft Office Excel. Findings showed that, even though the majority (60%) revealed the fact that rocket stoves are efficient in terms of firewood, adoption was only high initially due to promotion by STT project and perceived benefit, later as the project phased out, adoption decreased due to loss of hope and socioeconomic barriers. Even those who adopted the stoves, only few (27%) had adaptive use as the majority turned into use of traditional stoves because the majority (84%) faced challenges in use of the stoves. Among the challenges were easy breaking of the stove, costs of running the stove when broken and cutting of wood into small pieces. Moreover, it was revealed that the rate of deforestation is still increasing despite the introduced stoves. It was therefore concluded that rocket stoves have not helped in control of deforestation. Hence, it was recommended that, people should respond positively towards such projects so that forests are sustained for both present and future generations. Also, the implementers should continue to visit the areas and work on the existing challenges so as to ensure effective adoption as well as use of the stoves even after the phase is off.
The cost of dialysis in low and middle income countries: A systematic review
(BMC Health Services Research, 2015) Mushi, Lawrencia; Marschall, Paul; Fleßa, Steffen
Background: The cost of dialysis in low and middle-income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries. Methods: PubMed and Embase databases were searched for the years 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported the cost of dialysis from low and middle-income countries. Results: The annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical costs especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers. Conclusion: The number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question of whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In the case of developing countries, expert interviews are often used for estimating missing information.
Assessment of outreach immunization services as a strategy to increase immunization coverage to reach Zanzibar National target of ninety percent: A case study - North “A” District of Unguja
(Mzumbe university, 2015)
Reaching the whole target population is one among the five essential components of the WHO/RED Strategy, and an operational approach to achieve immunization coverage. Different approaches for reaching target population enhance delivering of the health services to a large proportion of the population, that is Outreach (fixed site or mobile), Mass campaign and Village Health Day and Nutrition, The study was conducted to assess the outreach immunization service as a strategy to increase immunization coverage to reach Zanzibar national target of ninety percent. The study was carried out as quantitative and qualitative descriptive case study design involving 100 respondents including 80 community members from 5 selected Shehia in North “A “District of Unguja (Bandamaji, Kinyasini, Kandwi, Fukuchani and Kigongoni); 13 service providers from Chaani Kubwa, Kidoti and Pwani Mchangani health facilities and; 7 supervisors from the District Health Management Teams. The information was obtained using guided interview questions, documentary review, and checklist/ observation. Data analysis was done by manual sorting, tallying, tabulation on master sheet through electronic software, and the results are presented in figures, tables and percentage (both qualitative and quantitative). The study findings revealed that the majority 46.15% of service providers interviewed were unskilled personnel (auxiliary worker) who execute outreach immunization services, with no reliable transport to track and follow up the outreach services, (23.75) % of the respondents agreed that outreach settings were not conducive to perform outreach services, and (16.25%) respondents were not satisfied with the services they received at the outreach setting. The study concluded that, factors limiting reaching unreached population include: weak supportive supervision (30%), weak male involvement (20%), and shortage of qualified staff (50%) to execute outreach immunization services and to reach all target population viii .Moreover, community suggested that to increase the number of resources, outreach services should be comprehensive and integrated as well as construction of health facility at every outreach setting to be put into consideration. The study recommended that the need to increase the demand for and supply of qualified staff so as to improve the utilization of health services and performance of the providers; to intensify community education on the use of the health services and to effectively provide supportive supervisions at regularly (at least monthly or quarterly) to improve staff performance
Quality of cataract services in Zanzibar: A case of Mnazi Mmoja hospital
(Mzumbe University, 2015) Makame, Abass Taha
Inspite of efforts taken to overcome the cataract related blindness, Zanzibar as one among sub-Saharan countries are far behind the WHO target for good visual outcome following cataract services. Zanzibar claimed to have 41% good visual outcome out of 95% WHO target while the reasons are not much clear, hence a quest to assess the quality of cataract services provided in Zanzibar in terms of: competency of human resource available, availability of medical requirement and level of staff compliance with the standard operation guidelines. To address the evaluation objectives a case study design was applied to assess the quality of cataract services in Zanzibar involving both qualitative and quantitative techniques. The evaluation had drawn its sample from cataract service providers, cataract patients and the heads of eye department in Mnazi Mmoja Hospital through convenient and purposive sampling procedures. Findings obtained from questionnaire, interview, observation and documentary review show that the case study hospital has only 39.1% of required skilled personnel. It has modern equipment and machines for quality cataract services. However, keratometer, B scan and YAG laser were not functioning while antibiotics for post operative and follow up care services were not adequately available to fulfil the requirements of all patients. About 75% cataract patients were not adequately received preliminary care as per guideline. 75.6% of patients received partial assessment for cataract surgical services while by 88.5% were fully assessed for critical events and anticipated variation as per standards. The evaluation conclude that the cataract services offered in the case study hospital was not as quality as expected since it had the following short comings: shortage of qualified human resources necessary for cataract services, shortage of medicines particularly antibiotics; lack of standard service guidelines, dysfunction of critical equipment and machines, and also inability of cataract service providers to adhere to standard guidelines.
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.
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.
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.
Defaulters tracing and retention of people living with HIV/AIDS (PLWHA), how far do peer performs this duty?: A case of Bunazi health centre in Missenyi District council
(Mzumbe University, 2015) Rwazo Levitas Revelian
The study principally intended to assess the role of peer educators in defaulter tracing and retention of people living with HIV/AIDS at Bunazi Health Centre in Missenyi District. The study was motivated by defaulting trend of PLWHA already on ART. The general objective was to assess the performance of peer educators, government and partners in defaulter tracing and retention of People Living with HIV/AIDS (PLWHA) at Bunazi Health Centre. The specific objectives were; to establish the extent at which PLWHA lost to follow up ,to examine likely factors that cause PLWHA to default from their appointment dates ,to identify the ways used by peer educators, government and partners in tracing defaulters and emphasizing the use of ARVs and adherence to prescriptions and hence retention of PLWHA, to compare the trend of defaulters before and after introduction of peer educators program and to explore staff , community perception and support to PLWHA The study employed descriptive design, purposive and stratified sampling technique was applied to get representatives sample of respondents were involved in the study. Data were collected through interviews, questionnaire, observation and documentary review. Data was managed at highly standardized procedures to ensure quality results. Coding, recoding, cleaning, processing and finally analysis and outputting of the results were conducted depending on the available software standards. SPSS statistical programme was used for data entry and analysis of quantitative data. The qualitative data was presented according to the findings in logical and sequential way so that conclusion can be drawn from them. The data was presented according to research question and research objectives, tables are used to present data. The study showed that at Bunazi health centre PE reduces the rate of defaulting from 6.1% in 2011 to 4.5% 2014.The recommendations capitalize on the sustainability of peer educators’ programme and close follow up of PLWHA at the community level in collaboration with VHW and HBC providers.
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.
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.
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 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.
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.
Perception and experiences of young key population on provision of responsive services for men who have sex with men & female sex workers: A case of pasada project, Dar es salaam Tanzania.
(Mzumbe university, 2016) Shayo, John Ambrose
Present disparities in access to HIV services among KPs are significant. Stigma and discrimination, violence, disciplinary harassment by police and social environments are major issues which fuel increased HIV vulnerability among KPs, thus availability, access, and uptake of HIV prevention, treatment, care, and support for MSM, sex workers and their clients are limited. In response to the problem both local and international NGOs collaborated in initiating and implementing a responsive programme for KPs in Dar Es Salaam, Tanzania. PASADA, PSI and the Government of Tanzania implement a programme with a focus on providing care and treatment services to MSM and FSWs in Dar Es Salaam. A descriptive qualitative study using in depth interviews and focus group discussions were employed. Seven KPs (Four MSM, three FSWs) were enrolled for in depth interviews and one FGD conducted with peers of KPs. Three service providers were recruited for in-depth interviews from PASADA clinic centre. We used Andersen’s Behavioral Models for vulnerable populations and a framework for Monitoring and Evaluation for marginalized populations as a framework to interpret on the perceptions and experiences on health seeking and influences on the provision of services by health providers for KPs The results highlight on the concerns of service providers lack of skills and low motivation related to the provision of services to KPs. KPs demonstrated awareness and knowledge of the comprehensive responsive services and issues which hinder accessibility. There was general unawareness of Hepatitis B and C, vaccination and appropriate prevention information among the group. The qualitative study underscores the significance of information on both HIV risks and acceptable, effective HIV prevention options for MSM and FSWs. Learning and skills development should be available to the wider KPs community. Drop-centre interventions may be excellence sites to address health problems experienced by MSM and FSWs.
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