6 research outputs found
Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries
Although the Human Resources for Health (HRH) crisis is apparently not
new in the public health agenda of many countries, not many low and
middle income countries are using Primary Health Care (PHC) as a tool
for planning and addressing the crisis in a comprehensive manner. The
aim of this paper is to appraise the inadequacies of the existing
planning approaches in addressing the growing HRH crisis in resource
limited settings. A descriptive literature review of selected case
studies in middle and low income countries reinforced with the evidence
from Tanzania was used. Consultations with experts in the field were
also made. In this review, we propose a conceptual framework that
describes planning may only be effective if it is structured to embrace
the fundamental principles of PHC. We place the core principles of PHC
at the centre of HRH planning as we acknowledge its major perspective
that the effectiveness of any public health policy depends on the
degree to which it envisages to address public health problems
multidimensionally and comprehensively. The proponents of PHC approach
in planning have identified intersectoral action and collaboration and
comprehensive approach as the two basic principles that policies and
plans should accentuate in order to make them effective in realizing
their pre-determined goals. Two conclusions are made: Firstly,
comprehensive health workforce planning is not widely known and thus
not frequently used in HRH planning or analysis of health workforce
issues; Secondly, comprehensiveness in HRH planning is important but
not sufficient in ensuring that all the ingredients of HRH crisis are
eliminated. In order to be effective and sustainable, the approach need
to evoke three basic values namely effectiveness, efficiency and
equity
FACTORS INFLUENCING QUALITY of HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) DATA: THE CASE OF KINONDONI DISTRICT IN DAR ES SALAAM REGION, TANZANIA
Objective: A study was done in Kinondoni Municipality, Tanzania, to
assess quality of data collected through the HMIS and explore possible
associated factors. Method: Using a structured questionnaire, health
facility in-charges were interviewed. Attributes of data quality were
recorded from health facility data using an observation schedule. A
total of 69 health facilities were involved in the study including all
(21) public health facilities and 25% (41/164) private facilities.
Completion rate of health facility data was used as a proxy for
measuring quality of data. Results: Although knowledge on HMIS basic
concept was found to be associated with improved quality of data,
training in HMIS did not seem to correspond with improved quality of
data. Regardless of duration, supervision had no relationship with
quality of data thus raising serious doubts on its quality. Presence of
a focal person, responsible for day to day HMIS activities, had a
positive influence on the quality of data where facilities with a focal
person had a higher data completion rate (69.9%) compared to those
without (44.7%). Accountability as measured by queries reportedly made
by Municipal authorities on data inaccuracies was associated with
better quality of data. However, queries on delay in sending report had
no influence in quality of data. Conclusion: The study concludes that
training, followed by supervision in HMIS, did not result into a
significant improvement of the quality of HMIS. There is need to
re-examine the current approaches used in training and supervision to
focus on actual needs of health workers. As a long- term goal, creation
of demand for processed data will serve to enhance ownership of the
system by health workers, hence improve data qualit
Health, wealth, and medical expenditures among the elderly in rural Tanzania: experiences from Nzega and Igunga districts
Abstract Background The per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. The gap between health needs and available resources for elderly healthcare is widening in many developing countries, like Tanzania, leaving the elderly in poor health. These conditions lead to catastrophic HEs for the elderly. This study aimed to analyse the association between measures of health, wealth, and medical expenditure in rural residents aged 60 years and above in Tanzania. Methods The data of this study were collected through a cross-sectional household survey to residents aged 60 years and above living in Nzega and Igunga districts using a standardised World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) and European Quality of Life Five Dimension (EQ-5D) questionnaires. The quality of life (QoL) was estimated using EQ-5D weights. The wealth index was generated from principal component analysis (PCA). The linear regression analyses (outpatient/inpatient) were performed to analyse the association between measures of health, wealth, medical expenditure, and socio-demographic variables. Results This study found a negative and statistically significant association between QoL and HE, whereby HE increases with the decrease of QoL. We could not find any significant relationship between HE and social gradients. In addition, age influences HE such that as age increases, the HE for both outpatient and inpatient care also increases. Conclusion The health system in these districts allocate resources mainly according to needs, and social position is not important. We thus conclude that the elderly of lower socio-economic status (SES) was subjected to similar health expenditure as those of higher socio-economic status. Health, not wealth, determines the use of medical expenditures
Challenges to the implementation of health sector decentralization in Tanzania : experiences from Kongwa district council
Background: During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective: This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design: The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results: The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers' accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion: The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process
Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania
Availability of drugs and medical supplies for emergency obstetric care : experience of health facility managers in a rural District of Tanzania
Background: Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC). Methods: In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach. Results: Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation. Conclusion: The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds