eajahme

Navigating the Challenges of Primary Health Care in Selected Local Government Authorities in Tanzania: Bringing Lipsky’s Theory in Its Requisite Panorama

Denis Kamugisha — 2024-10-05

Introduction

The robust delivery of primary health care (PHC) service is a complex interplay of key stakeholders, including policymakers, citizens, the government, parliamentarians, academics, and street-level bureaucrats - health staff in this context. While each of these players has a stake in ensuring robust PHC delivery, this paper specifically examines the role of street-level bureaucrats (SLBs) in dealing with service delivery challenges in Local Government Authorities (LGAs) in Tanzania. Although the engagement with these actors gained momentum in the decentralization reforms of the 1990s, their contribution has been slow. The question remains: How can SLBs cope with LGAs’ predicaments to enhance service delivery? Lipsky’s (1980) theory focuses on this contention by proposing that under challenging encounters, SLBs can develop specific patterns of practices to deal with the status quo.

Methods

Data were collected through interviews with policymakers at Mvomero District and Moshi Municipal Councils. To assess the effectiveness of primary health care services attributes such as authority, accountability, and access were closely examined. A thematic review of the literature was conducted to corroborate the findings from the interviews.

Results

The findings indicate that SLBs can cope with complex and challenging situations related to PHC delivery by rationing resources, simplifying their work environment, or exiting from turbulent environments. Although the engagement of SLBs gained momentum during the decentralization reforms of the 1990s, their contribution has been slow. The primary factor hindering their effectiveness is the inability to establish a mutually beneficial relationship between the Central Government and LGAs.

Conclusion

The government's attempts to control SLBs' behaviors, including limiting their intrinsic and extrinsic motivation, undermine their client responsiveness. Empowering SLBs and fostering a more collaborative relationship between the central government and LGAs is essential to enhance PHC delivery.

Evaluating the Utilization of Human Resources for Health Information Systems at the Local Government Level: Findings from the Kilimanjaro Region

Anna Mmbando — 2024-08-11

Introduction: Human resources for health (HRH) are critical to healthcare delivery. Global HRH shortages hinder health service provision. This study explored how data from HRHIS is utilized to optimize HRH planning, management, and development.

Methods: The study used a utility-focused evaluation approach, employing multiple case study designs. Data were collected from seven (7) of the Ministry of Health and President's Office—Regional Administrative and Local Government through in-depth interviews and an observation checklist, whereas ten (10) participants were interviewed. Interpretative phenomenological analysis was used to describe individual experiences, practices of HRH management, and data use from HRHIS.

Results: The study found that staffing levels, DHIS2, Work Indicators, Staff Needs and Prioritization, and Optimization Analysis are key data sources for HRH planning, allocation, and deployment decisions. However, relying on multiple systems for employee data management proved challenging due to inconsistencies and errors. While essential, HRHIS lacks integration with other systems, hindering data utilization. Manual data entry further exacerbates data quality issues, emphasizing the need for a more robust and integrated HRH information system.

Conclusion: HRHIS is a valuable tool for HRH data management, but its potential is underutilized in Kilimanjaro. Despite implementation, challenges persist in using HRHIS data for planning, management, and development. Significant efforts are needed to promote data utilization and improve HRHIS's contribution to Tanzania's healthcare workforce. The study recommends accelerating the integration of HRHIS with other systems, such as the District Health Information System, the Human Capital Management Information System, Professional Councils databases, Regulatory bodies – Tanzania Commission for University, NACVET, Health Facility Registry, and TrainSmart. This integration will enhance data accessibility and improve HRH planning and management.

Assessing the Capacity of Quality Improvement Teams on Health Data Use for Improvement of Health Service Delivery in Council Hospitals in Tanzania

Constantine Matimo — 2024-08-08

Abstract

Introduction: The ability of health workers in data use is pivotal in the healthcare system; it helps to facilitate effective data use to improve healthcare services in health settings. This study aimed to assess the capacity of hospital Quality Improvement Teams members to utilize health data in selected council hospitals in Tanzania.

Methods: We conducted a cross-sectional study involving 12 council hospitals in six regions. Data were collected from 203 members of Quality Improvement Teams using a self-administered questionnaire. We utilized Smart PLS 3 and conducted a bootstrapping analysis to assess the formulated hypotheses.

Results: The results show that most of the respondents have limited knowledge and skills in data visualization and sharing through dashboards (37.4%), data dissemination through notice boards (38.9%), and data review and interpretations through quarterly quality improvement team meetings (40.9%). Additionally, the majority of respondents indicated low knowledge and skills in ordering essential health commodities (50.3%), allocating hospital staff (45.3%), and preparing hospital plans and budgets based on existing data systems (50.7%).

Conclusion: Members of Quality Improvement Teams demonstrate a lack of proficiency in utilizing data, which has had a significant impact on the delivery of health services. Accordingly, it is imperative to focus on enhancing the capabilities of all personnel within health settings to comprehend and effectively apply techniques for data analysis, interpretation, data visualization, and sharing.

Health-Related Quality of Life for the Insured and Non-Insured Elderly in Rural Tanzania: A Cross-Sectional Study

Malale Tungu — 2024-07-06

Introduction

The growing number of elderlies in low—and middle-income countries is straining healthcare systems. Affordable health services are essential to prevent poor health outcomes and low quality of life. Health insurance can improve access to care and enhance the quality of life for elderly individuals. This study compares the quality of life of elderly individuals with and without health insurance.

Methods

A household survey was conducted in the Nzega and Igunga districts in the Tabora region of Tanzania from 2017 to 2022. The survey used a multistage sampling method to select wards, villages in each district, and households with elderly residents. The European Quality of Life 5-dimension 3-level (EQ-5D-3L) instrument was used to assess health-related quality of life (HRQoL), including the EQ-5D descriptive system and the EQ visual analog scale (EQ VAS). Value sets from Zimbabwe were used to calculate HRQoL. The survey used crude and adjusted linear regression analyses to assess the relationship between HRQoL and HI by accounting for confounding factors.

Results

A total of 1,899 elderly individuals aged 60 years and above participated in the study, with the majority (58%) falling in the 60-69 age group. Among the participants, 45% were married, and only 44% had insurance coverage. The overall mean EQ-5D and EQ-VAS scores were slightly higher for the uninsured elderly (0.75 and 61.20) compared to the insured elderly (0.73 and 60.31). According to the linear crude model, there is a decrease in HRQoL among the uninsured compared to the insured. This trend was also observed in the adjusted model, although it was not statistically significant (p=0.052).

Conclusion

Access to health insurance can significantly improve the HRQoL for elderly populations in Tanzania. These findings are crucial for policymakers. Extending health insurance coverage to vulnerable sub-populations like the elderly should be a priority, with targeted financial subsidies for HI premiums. This initiative would be a significant step towards achieving universal health coverage in Tanzania, ensuring a higher quality of life for all citizens.