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Effectiveness of result based financing programme on utilization of maternal health services in Urambo
(Mzumbe University, 2018) Njopeka, Abdilahi N.
Background: Introduction of RBF to Africa resulted from increased maternal death and decreased national expenditure on health sector (Africa Progress Panel, 2010). In Tanzania, RBF was introduced in 2015, rolled-out to Urambo district in 2017. This study evaluated the worth of RBF on utilization of maternal health services through paying incentives, improving infrastructure and purchasing commodities to health facilities.
Methodology: Quasi experimental evaluation study conducted in Urambo district where multistage sampling was used to select households from RBF facilities as intervention participants and non-RBF facilities as control participants. Baseline data was collected from DHIS 2, associations tested using Chi square (95%) and 0.05 P-value.
Results: Institutional delivery cumulated 51% of incentives paid to health staff, implying that staff are motivated to perform duties with high incentives (20,720 Tshs/client) compared to the less paid of IPT 2 (1,240 Tshs/client) that demonstrated a drop of 11.7% after RBF implementation. The availability of 50% of medicines at maternity ward suggested the presence of other funds source. Changes from 0% to 61.3% state of building repair and an increase in availability of power and water sources by 82.9% and 50% respectively suggested improved facility infrastructures. Utilization of services increased for 43.3% in institutional delivery and 9.6% for prenatal visits >12wks were associated with incentives and infrastructure (P-values 0.006, 0.023; 0.001, 0.014).
Conclusion and Recommendations: RBF was effective on utilization of maternal health services but limited to prenatal visits >12wks and institutional deliveries with effect size of 0.12 and 0.21 respectively. It is recommended that non-monetary form of incentive should be directed to clients in order to advocate the concept of RBF to the community, and the CHMT should provide technical support to health facility management team and make effort to community health education on the importance of completing four prenatal visits before delivery.
Evaluation of the implementation process of health system strengthening program towards improving emergency obstetric and newborn care services: A case of selected health facilities in Kisarawe District
(Mzumbe University, 2018) Mwandiki, Martin Felician
Background: In this 21st century with well advanced technology on medical treatment we still lose a number of women and childrenn during childbirth in Tanzania. Emergency obstetric care is one of the strategies for reducing death during childbirth. Objectives: The aim of this study was to evaluate the implementation process of health system strengthening program towards improving emergency obstetric and newborn care services specifically, ability of the health facilities on providing EmONC services after health system strengthening. The goal of the project has been to improve EmONC services by ensuring availability of funds for training of health staff, procurement of medical equipment and supplies to the health facilities of Kisarawe district.
Methodology: A cross-sectional descriptive study was conducted to 15 health facilities in the period of 2015-2017. The methods of data collection employed were mixed methods of data collection whereby the data was collected through face to face questionnaires to coordinators of the program, structured questionnaire administered to health staff, observation checklist and documentary review of the facilities` records. Descriptive analyses such as bar charts, histograms, line charts and percentages were employed. Results: The amount of support was not adequate since the program managed to support just four facilities out of 35. Merely 19%-20% of staff were trained for EmONC services, and almost all were from the district hospital. There was a shortage of medical equipment by 39.1-56.5% and medical supplies by 40-65% for EmONC services to all selected health facilities except the district hospital.The dispensaries and health centers could provide EmONC services at rate of 22.2-44.4% except the district hospital which had 100 percent. Conclusions: The implementation process of health system strengthening towards improving EmONC services at selected health facilities is not implemented successfully.
Recommendations: There is a need of more funds, and the district should see to it that the program is implemented more effectively to realise set objectives and the Government of Tanzania should also increase its stewardship.
People's perception on mosquito net performance: A cross-sectional study in the north-western part of the Lake Zone in Tanzania
(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 having not enough nets and bed nets being too old or 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 wearing and tear, 5 nets survived out of 10 nets after 3 years and 4 nets sustained field condition 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 associates 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 difference 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 (MHIF):The case of Bugando Referral Hospital
(Mzumbe University, 2015) Mtwe, Joseph Nyamhanga
Patients’ satisfaction under National Health Insurance Fund (NHIF):The case of Bugando Referral Hospital 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
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.