Health System Management Monitoring & Evaluation(HSME)

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Actors associated with utilization of immediate postpartum family planning services among post delivery mothers: A case of Chaguo la Maisha program in Ilala Dares salaam
(Mzumbe University, 2019) Ntambuto, Rose Marco
Introduction: Family Planning (FP) program is a key strategy for reducing maternal, infant and child morbidity. Effective Provision of PPFP prevents unplanned pregnancy during 12 months after delivery. Objective: The aim of this evaluation was to evaluate factors associated with utilization of IPPFP in Ilala Municipality. Methods: Descriptive Cross-sectional study design deployed both quantitative and qualitative methods for data collection and analysis. Selection of six Health Facilities used probability sampling strategies, with cluster sampling, non-probability sampling technique was used to select 395 who were selected conveniently and were given coded structured, translated to Kiswahili and pre-tested questionnaire to collect data. Quantitative observation checklist was used to quantify resources availability. Data were entered into the Microsoft excel sheet and imported into the STATA version 13 for data cleaning before analysis. Chi square test analysis was used to create the relationship between IPPFP services and the utilization of it. For Qualitative data, Purposive sampling methods were used to select health workers who had key information, and used in depth interview guide. Content analysis was used to analyze the data, transcription of the interview, formation of meaning units, condensation of the unit followed by codes formation then themes were created to produce report. Findings: The study findings show 79(20) % of clients were discharged with IPPFP. Aassociation was found between IPPFP use and counseling session (p-value 0.023), session clearly understood (p-value 0.030). Another finding which has no association was stock out of medical supplies and equipment for IPPFP, (p-value 0.360) and adequate room (p-value 0.332). Conclusion: There is low utilization of IPPFP use in Ilala Municipality. Reason for not using the service were; pain following delivery, not discussed with their husband, fear from side effect of methods and husband not approved to use IPPFP. Recommendation: Therefore, individual counseling, community and male involvement should be promoted to increase IPPFP utilization.
An assessment of family planning program data quality: A case of Tarime District
(Mzumbe University, 2018) Sufian, Magetta S.
BACKGROUND: Family planning encompasses the accessibility of services, policies, information, attitudes, practices and commodities, that gives women, men, couples, and adolescents the ability to avoid unintended pregnancy and choose whether and or when to have a child and the preferable number of children. It is a cross-sectoral intervention that can hasten progress across the sustainable development goals (Starbird, 2016). Inadequate information and poor data quality on family planning intervention program seems to affect contraceptives uptake records across different level of response. Investing on family planning program data quality assessment can bridge up the gap between the observed differences. OBJECTIVES: The aim of this evaluation study was to determine the tools used by health care providers in recording and reporting family planning data at facility levels, to assess how data collected at different levels with different organisation have similarities, and exploring how different organizations assess family planning data quality collected at different levels. METHODS: The study was conducted at Tarime district in the DMO’s office, 19 health facilities, RMO’s office and Program’s office. Qualitative research design was used in this study, purposive sampling methods applied, the researcher used both primary and secondary data through questionnaires and documentary review respectively, and lastly data analysed by excel and Atlas.ti software. RESULTS: Family planning data recording and data reporting tools was available in all public health facilities visited, however, there were data disparity between health facility and district level, as well as District and Regional office. Though data similarities were observed between District office and program office. Data quality assessment was not vii done in the health facilities for almost 90% but seems to be done at the District and in the Regional levels in collaboration with partners. CONCLUSSION: The findings concluding that Family planning program use MTUHA book no 8 which consist of three books namely registers, tally sheet and summary report books as a data recording and data reporting tools in the health facilities, despite that tools are available but still the quality of data remained doubtful due to data disparities observed in the documentary review across different level of response. Family planning data quality assessment is only performed at the District and in the Region level but rarely and improperly conducted at facility levels due to some observed challenges like inadequate knowledge for FP DQA, lack of skilled team, lack of standardized data quality assessment tools, mistrust of data collectors at different levels, data manipulation to fulfil donors requirements, parallel reporting and report overburden at the health facilities.
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 Frank
Background: 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 levels
Assessing factors influencing reporting of weekly diseases data from regions to Ministry of Health and Social Welfare in Tanzania Mainland
(Mzumbe University, 2015) Moshi, Frank Solomon
Background: 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 52th 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 levels.
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 Rwechungura
This 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.
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.
Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund
(Mzumbe University, 2015) Swai, Denis F.
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. Conclusions: All three attributes - Structure of the health facility, process and treatment outcomes significantly influence CHF members satisfaction 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 association with service provided.
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 provided
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.
Assessment of longterm contraceptive utilization among women of reproductive age : A case of Kibaha town council
(Mzumbe University, 2019) Yusuph, Phidman
Family planning is important in the community as it gives an opportunity for the individual to make decision on the number of children they wish to have, but also it prevent unintended pregnancy which lead to abortion especially unsafe abortion. For those women who are using family planning they have a chance to restore their health wellbeing. Economically it’s also benefiting the couple as they can make plans of their life depending with the number of children they have or they wish to have. The study approach was sequential mixed study which involved both quantitative and qualitative. The sample size quantitatively was determined by using Yamane formula and the sample size obtained was 396. On the other part of qualitative, the data were collected until saturation from key informants. Quantitative data were analysed by assistance of Stata and that the descriptive statistics finding were presented in percentage, charts and tables. Logistic regression used in analysis so as to give out inferential statistics findings, The qualitative data were analysed with the assistance of Atlas ti ,according to the views from the key informant’s especially health care providers and DRCHCO, they said education level and living in urban makes women to be aware on LARC services as also they proved that myths and misconceptions on the LARC, religious, availability of the services and husband decision on FP use have been obstacles for the women to use Long Acting Reversible Contraceptive methods. The study recommends efforts from different stakeholders and the Government to put much emphasis on ensuring that the health education on family planning especially LARC is reaching the community and male involvement it’s also a key Knowledge and awareness is the source of women and the community in large to change their behavior towards the use of long acting Contraceptive methods and avoid them from unwanted pregnancy which could lead to unsafe abortion and death. Key words: Long Term Contraceptive; Utilization; reproductive age; Kibaha
Assessment of medical waste management in health facilities: A case study of Makambako health centre
(2017) Mwakanyamale, Nuru
INTRODUCTION: Healthcare wastes pose health problems to the people and affect environment in general. Since the WHO set rules and principles of handling medical wastes but in health facilities health workers lack awareness and knowledge on how to handle those medical wastes whereby there are no training sessions and seminars to them. OBJECTIVES: The objectives of this study were to determine the practices of medical waste management at Makambako Health Centre, examining awareness to health workers and assessing the factors affecting adherence to the MWM at Makambako Health Centre (MHC) to avoid occurrence of health hazards to those interacted with those medical wastes including patients and environment around the area. METHODS: The researcher made use of both primary and secondary data. The study also employed the use of cross section method to describe the BWM since it involve 60 of Health workers included in the study from Health facility using purposive sampling technique. A semi structured questionnaire and observational check list were used to collect data. Data were entered and analyzed using SPSS. FINDINGS: The study has revealed the following key findings it indicates that generally level of awareness of health workers in government strategies to address medical waste was 65.4% and only 34.6% were not aware. Also 82.7% said the practices are satisfactory and 19.3% said the practices are not satisfactory since are encountering different challenges in the medical waste handling practices including getting injuries when handling wastes. RECOMMENDATIONS: From the research findings study recommend that there is a need of having regular training programs to all workers in order to help them to know the risks associated with poor management of medical wastes also the notification of quantity of wastes generated to enable the proper allocation of resources in medical waste management.
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 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
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.
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 the quality of postnatal care services: A case study of Mbeya District Council
(Mzumbe University, 2015) Lotto, Theopista, David
Background: 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 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 Steven
Background: 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.
Attitude of community members towards the capacity of the village land councils in managing land use conflicts between farmers and pastoralists in Tanzania: A cross sectional case study analysis
(E-palli publishers, 2024) Homera , Juma Zuberi; Mollel, Henry A.
Village Land Councils have been established to resolve land use conflicts in rural Tanzania. The history reveals that Tanzania has been mostly affected with the endless land based conflicts between farmers and pastoralists. The presence of VLCs in rural Tanzania has brought significant changes in rural areas where farmers and pastoralists compete to utilize and possess scarce resources. However, rural dwellers have different opinions on the worthiness of the respective local organs in resolving land use conflicts between farmers and pastoralists. This study therefore intended to explore attitudes from the community members towards the capacity of the Village Land Councils in managing land use conflicts between farmers and pastoralists. Semi-structured interviews were used to collect data, where a semantic differential scale was used as the appropriate tool for exploring attitudes from the respondents, particularly: farmers and pastoralists who mostly rely on VLCs for mediation services. Vivo software 14 was used for analysing such data. The results indicated that majority of respondents (farmers and pastoralists) in Mbarali and Kilosa District Councils had positive attitude towards VLCs due to their performance in resolving land use conflicts between farmers and pastoralists. Similar response was obtained from the farmers operating in Tunduru District Council. However, some pastoralists in Tunduru District Councils had remained sceptical on the capacity of the VLCs to resolve conflicts and create conducive working environment for both conflicting parties. Their doubts relied on injustice practices such as corruption, nepotism and tribalism that were directly associated with VLC members. Based on the findings, the study suggests for more capacity building programs for enhancing the capacity of VLC members to act firmly and objectively and for the community members so that they develop a sense of responsibilities in supporting the VLCs’ operations for the
Changing Dietary Practices: The new food insecurity among the pastoralists in Mabwegere village Kilosa district
(The Mwalimu Nyerere Memorial Academy, 2020-06-15) Massoi, Lucy; Saruni, Parit
While global and national efforts are increasingly aiming at ending all forms of malnutrition by 2030, food insecurity levels are increasingly high among the pastoralist communities in the sub-Saharan Africa. This scenario is attributed to by the existing efforts and strategies, which are predominantly preoccupied with the narrative that, people are food secured when everyone has access to sufficient, safe, nutritious food to maintain a healthy and active life at all the time. This perspective overlooks the presence of heterogeneous communities with different cultural beliefs about health, livelihoods, and sustainability of food supply. This article argues that, food security does not only concern with food availability but also traditional dietary preferences. This study used a qualitative case oriented design and data were collected through key informant interviews and focus group discussions. Food production among the Maasai is increasingly inadequate, and traditional dietary practices among the Maasai pastoralists is increasingly changing as a result of agrarian transformation in the Kilosa District in Tanzania. This is where large chunks of land are transformed for agricultural activities as a way of increasing food availability in terms of the number of meals intake and the type of meals consumed. Conventional dietary meals such as cereals and green leaves are increasingly consumed with a decreasing number of meals consumed per day and the changing of the type of meals consumed. Therefore, the analysis of food and nutrition security should understand that, cultural food preferences are important because they are interconnected with beliefs about health, livelihoods and sustainability of food supply. This study suggests that policies that address food and nutrition insecurity need to take on board the close relationship between food, nutrition security, and culture. It is important for communities to embrace other alternatives for livelihood, including farming and government support in irrigation to improve food access and availability.
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.