On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

Background: Strategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services.Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area. Methods: Data was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and 654 ANC visits. Determinants were analysed using multivariate regression. Results: Almost all women had attended ANC, though only 58.3% had 654 visits. 654 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32\u20135.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04\u20134.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50\u20134.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59\u20136.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20\u20134.91, p=0.02). Conclusion: Rural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities' access to facilities

A proposed framework for the implementation of community based health initiatives(CBHI)in the context of reforms in TANZANIA:enabling households and communities to take effective for the improvement of their own health development

\ud A team of I 0 local and one external consultants was contracted to review the implementation of CBHI in Tanzania. The objective of the review was to develop a framework for the implementation of CBHI in the districts; in the wake of Health and Local Government Reforms. Specifically, the team set out to review: Conununity Based Management of CDHC (Situation analysis, Planning, Implementation, Monitoring, Evaluation, and Feedback), Community Based Health Information Systems, Community Based Resource mobilization, Community Based Human resource management, Community Based provision of the essential health service package,Community Based Communication Strategy for Health development and behavior change, Community Based Coordination and linkage for health initiatives.\ud \ud In the course of the review, the team visited 11 districts with the aim of identifying best practice in Community Based Health Initiatives (CBHI) in Tanzania. Lessons derived from district experiences were to be included in this framework so as to guide the scaling up of this appro:!ch throughout the country, as a key element of the Health Sector Reform (HSR) process.\ud \ud Information gathering was undertaken through desk review, key informant interviews, and group discussions as well as observation of ongoing activities at National, District, Ward and Village levels. Visits were made to a total of 11 Districts (and 40 villages, 21\ud Wards). A second visit was paid to two Districts to validate the findings and. s s relevance of strategic actions-suggested by the team. Key infonnants and groups interviewed included: District Management Team (DMT), District Health Management Team (DHMT), Ward Development Committee (WDC) members, Village Chairpersons and Executive Officers, Kitongoji Chairpersons, other Village leaders and ordinary community people at Village Assemblies.\ud \ud In general, the Review Team found that CBHI implemented in whole Districts over a long period of time were associated with a series of indicators of improved health status, household health behaviour, and community services.\ud \ud In Mufmdi District, for example, quarterly pregnancy monitoring reports submission increased from 72% to 88%. Maternal Mortality dropped from 900/100,000 in 1991 to\ud 397 in 1993. Child mortality from 107/1000 to 90/1000 live births. Immunization\ud coverage reached 92% in 1990 and stabilized at 80% from 1994 to date. Family Planning acceptance has reached 75% in some villages. Severe malnutrition had gone down from an average of7 to 1 case per quarter in one of the villages visited. The number ofhouses constructed using pennanent materials had also increased eight-fold during the project\ud period indicating the possibility of an improving economic base. Access to water sources had improved to the level of 80% of households having access to safe water within 30 minutes walk. The villages visited had not experienced an outbreak of cholera for the past three years. In addition, roads to the villages had been improved anmaintained in good condition.\ud \ud There was increased proportion of women in Village committees reaching up to one third (8/20) in some of the villages. These achievements were attributed to the use of participatory approach in planning and implementation of CBHI.\u

Jazia prime vendor system- a public-private partnership to improve medicine availability in Tanzania: from pilot to scale

Abstract Background The availability of medicines in public health facilities in Tanzania is problematic. Medicines shortages are often caused by unavailability at Medical Stores Department, the national supplier for public health facilities. During such stock-outs, districts may purchase from private suppliers. However, this procedure is intransparent, bureaucratic and uneconomic. Objectives To complement the national supply chain in case of stock-outs with a simplified, transparent and efficient procurement procedure based on a public-private partnership approach with a prime vendor at the regional level. To develop a successful pilot of a Prime Vendor system with the potential for national scale-up. Methods A public-private partnership was established engaging one private sector pharmaceutical supplier as the Prime Vendor to provide the complementary medicines needed by public health facilities in Tanzania. The Dodoma pilot region endorsed the concept involving the private sector, and procedures to procure complementary supplies from a single vendor in a pooled regional contract were developed. A supplier was tendered and contracted based on Good Procurement Practice. Pilot implementation was guided by Standard Operating Procedures, and closely monitored with performance indicators. A 12-step approach for national implementation was applied including cascade training from national to facility level. Each selected vendor signed a contract with the respective regional authority. Results In the pilot region, tracer medicines availability increased from 69% in 2014 to 94% in 2018. Prime vendor supplies are of assured quality and average prices are comparable to prices of Medical Stores Department. Procurement procedures are simplified, shortened, standardized, transparent and well-governed. Procurement capacity was enhanced at all levels of the health system. Proven successful, the Prime Vendor system pilot was rolled-out nationally, on government request, to all 26 regions of mainland Tanzania, covering 185 councils and 5381 health facilities. Conclusion The Prime Vendor system complements regular government supply through a regional contract approach. It is anchored in the structures of the regional health administration and in the decentralisation policy of the country. This partnership with the private sector facilitates procurement of additional supplies within a culture of transparency and accountability. Regional leadership, convincing pilot results and policy dialogue have led to national roll-out. Transferring this smaller-scale supply chain intervention to other regions requires country ownership and support for sustainable operations

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

BACKGROUND: Strategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area. METHODS: Data was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression. RESULTS: Almost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32-5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04-4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50-4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59-6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20-4.91, p=0.02). CONCLUSION: Rural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities' access to facilities