scholarly journals The Functionality of Health Facility Governing Committees and Their Associated Factors in Selected Primary Health Facilities Implementing Direct Health Facility Financing in Tanzania

2022 ◽  
Author(s):  
Anosisye Kesale ◽  
Christopher Mahonge ◽  
Mikidadi Muhanga
Keyword(s):  
Community Health ◽  
Health Facility ◽  
Associated Factors ◽  
Fiscal Decentralization ◽  
Health Facilities ◽  
P Value ◽  
Primary Health ◽  
Sampling Procedures ◽  
Primary Health Facilities ◽  
The Impact

Abstract Background: Decentralization has dominated the agenda for the reforms of the organization of service delivery in Lower and Middle-Income Countries (LMICs). Decentralization faces a formidable challenge of fiscal decentralization in primary healthcare facilities. Of now, LMICs are implementing fiscal decentralization reforms to empower health facilities and their Health Facility Governing Committees (HFGCs). Given the paucity of the impact of fiscal decentralization, this study was conducted to assess the functionality of HFGCs and their associative factors in primary health care facilities implementing fiscal decentralization through Direct Health Facility Financing (DHFF) in Tanzania.Methods: A cross-sectional design was employed to gather both qualitative and quantitative data. The study was conducted in 32 selected primary health facilities implementing DHFF in Tanzania. Probability and nonprobability sampling procedures were employed, in which a multistage sampling procedure was used to select 280 respondents. Data were collected through a structured questionnaire, in-depth interviews and focus group discussions. Descriptive analysis was employed to determine the functionality of HFGCs and binary logistic regression was employed to determine associated factors for the functionality of HFGC. Qualitative analysis was done through thematic analysis.Result: HFGC functionality under DHFF has been found to be good by 78.57%. Specifically, HFGCs have been found to have good functionality in mobilizing communities to join Community Health Funds 87.14%, participating in the procurement process 85%, discussing community health challenges 81.43% and planning and budgeting 80%. The functionality of HFGCs has been found to be associated with the planning and budgeting aspects p-value of 0.0011, procurement aspects p-value 0.0331, availability of information reports p-value 0.0007 and Contesting for HFGC position p-value 0.0187.Conclusion: The study has revealed that fiscal decentralization through DHFF significantly improves the functionality of HFGCs. Therefore, the study recommends more effort be put into facilitating the availability of finances to the health facilities.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

scholarly journals Impact of Covid-19 on the Outcomes of Basic Immunization in Health Facilities

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Retno Setyo Iswati ◽  
Indria Nuraini
Keyword(s):  
Significant Relationship ◽  
Immunization Coverage ◽  
Health Facilities ◽  
Children's Health ◽  
Independent Practice ◽  
Chi Square ◽  
Primary Health ◽  
Chi Square Test ◽  
Primary Health Facilities ◽  
The Impact

The purpose of this study was to determine the impact of Covid 19 on basic immunization coverage, oriented to the number of Covid 19 cases mapped in the red, yellow, and green. This research provides the advantage of making a policy to improve children's health during a pandemic, particularly in preventing diseases that can be anticipated by immunization, such as tuberculosis, diphtheria, hepatitis, tetanus, meningitis, polio, and measles. This research can also be used as a basic for immunization in health facilities while still implementing health protocols. This study's results can be implemented in primary health facilities such as the Puskesmas, Posyandu, Poskesdes, or Midwife Independent Practice. This study's results indicate that immunization coverage <95% is mostly found in the red zone area of Pentabio 1 and 2 immunization, as well as measles. Chi-square test found that there was no significant relationship with basic immunization coverage.

scholarly journals Magnitude and associated factors of disrespect and abusive care among laboring mothers at public health facilities in Borena District, South Wollo, Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0256951
Author(s):  
Mulusew Maldie ◽  
Gudina Egata ◽  
Muluken Genetu Chanie ◽  
Amare Muche ◽  
Reta Dewau ◽  
...  
Keyword(s):  
Health Facility ◽  
Wealth Index ◽  
Health Facilities ◽  
Systematic Sampling ◽  
P Value ◽  
Multivariable Logistic Regression Analysis ◽  
Disrespect And Abuse ◽  
Care Providers ◽  
The Impact ◽  
Significant Factors

Background Recent studies have indicated that disrespectful/abusive/coercive service by skilled care providers in health facilities that results in actual or perceived poor quality of care is directly and indirectly associated with adverse maternal and newborn outcomes. According to the 2016 Ethiopian Demography and Health Survey, only 26% of births were attended by qualified clinicians, with a maternal mortality rate of 412 per 100,000 live-births. Using seven categories developed by Bowser and Hill (2010), this study looked at disrespect and abuse experienced by women in labor and delivery rooms in health facilities of Borena Ddistrict, South Wollo, Ethiopia. Methods A facility-based cross-sectional study was conducted among 374 immediate postpartum women in Borena District from January 12 to March 12, 2020. Systematic sampling was used to access respondents to participate in a structured, pre-tested face-to-face exit interview. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Finally, bivariable and multivariable logistic regression analysis were performed to declare statistically significant factors related to maternal disrespect and abusive care in Borena District at a p-value of < 0.05 and at 95% CI. Result Almost four out of five (79.4%) women experienced at least one type of disrespect and abuse during facility-based childbirth. The most frequently reported type of disrespect and abuse was non-consented care 63.7%. Wealth index [AOR = 3.27; 95% CI: (1.47, 7.25)], type of health facility [AOR = 1.96; 95% CI: (1.01, 3.78)], presence of companion(s) [AOR = 0.05; 95% CI: (0.02, 0.12)], and presence of complications [AOR = 2.65; 95% CI: (1.17, 5.99)] were factors found to be significantly related to women experiencing disrespect and abuse. Conclusion The results showed that wealth index, type of health facility, presence of companion(s), and birth complications were found to be significant factors. Therefore, health personnel need to develop interventions that integrate provider’s behavior on companionship and prevention of complications across facilities to reduce the impact of disrespectful and abusive care for laboring women.

scholarly journals Work motivation and job satisfaction among health workers of primary health facilities: a mixed-methods study from Nepal

2020 ◽  
Author(s):  
Pratik Khanal ◽  
Bishnu P Choulagai ◽  
Pawan Acharya ◽  
Sharad Onta
Keyword(s):  
Job Satisfaction ◽  
Mixed Methods ◽  
Career Development ◽  
Health Facility ◽  
Work Motivation ◽  
Health Workers ◽  
Health Facilities ◽  
Mixed Methods Study ◽  
Primary Health ◽  
Primary Health Facilities

Abstract Background Work motivation and job satisfaction are linked with the performance and retention of health workforce. Primary health facilities, mostly comprising of mid-level health workers, serve majority of the population in Nepal. The aim of the study was to assess the determinants of job satisfaction in relation to socio-demographics, job characteristics and work motivation status among health workers working in primary health facilities. Methods A mixed-methods study was conducted in Jhapa district in Eastern Nepal covering 40 primary health facilities. The data collection involved 151 self-administered questionnaire interviews and 16 in-depth interviews with the health workers. Mean differences in work motivation among those satisfied and unsatisfied with their job was examined using t tests. Logistic regression with 95% confidence interval at p<0.05 was used for identifying associated factors with job satisfaction. Thematic analysis was done for qualitative data. Results Among the study participants, 78.2% were either auxiliary health workers or auxiliary nurse midwives. The median employment period of health workers was 174 months. In the likert scale of five points, the mean score of work motivation was highest for team work (3.99) and lowest for financial motivation (2.21). Age of health workers and satisfaction with career development, and financial motivation were significantly associated with job satisfaction. The qualitative findings also revealed that majority of the health workers were not satisfied with the existing career development opportunities, availability of resources in health facility and financial motivation. Conclusions Dissatisfaction with career development and financial motivation was significantly associated with lower odds of job satisfaction among health workers. Additionally, resource availability in health facility, recognition of work and management support affected job satisfaction. A focus on improving work environment through increased financial motivation and career development opportunities as well as investing in primary health facilities with increased resource support is recommended to improve job satisfaction.

scholarly journals An Examination of the Determinants of The Mode of Transport to Primary Health Facilities in A Developing Region

2014 ◽  
Vol 46 (2) ◽  
pp. 167
Author(s):  
Olayinka Otun ◽  
Adeolu Dina ◽  
Adeola Bamigboye
Keyword(s):  
Health Facility ◽  
Care Service ◽  
Health Care Service ◽  
Health Facilities ◽  
Rural Regions ◽  
Public Facilities ◽  
Primary Health ◽  
Developing Region ◽  
Primary Health Facilities ◽  
Primary Health Facility

Access to primary health facilities is a key determinant of the overall well being of the population in an area.   In rural regions were distances to public facilities are usually longer compared to urban areas, it is not clear if people are still willing to walk to use these facilities. It is pertinent therefore to clarify such uncertainty since walking distance is a standard measure used to plan such public facilities particularly in rural regions. The objective  of this study therefore is to provide a framework to determine the factors that will influence a health care service seeker in a developing region to walk or use other means of transport to a primary health facility.  The case study for this research is Ijebu North Local Government Area of Ogun state made up of eleven urban and rural wards. One hundred and fifty households were selected at random for interview. Logit regression was used to describe how some predictor variables were used to explain the likelihood of a particular household walking to a primary health facility. The predicting model  in this study was able to classify 80.0% of the cases correctly.   This simply shows that the predictors (independent variables) contribute to the predicting power of the logistic regression model.   The  pseudo R-squares of Cox and Snell’s R-square and Nagelkerke’s R also show that our logistic model is relevant to predicting whether a household will walk or use a vehicle while attending a health facility.   In our study, we noted that settlement status (p=0.00)  and transport cost to health facility (p=0.00) contributed significantly to the prediction.  This study also reveals that the odds for household members in an urban area to walk to the health facility often used  is 88.1%  lower than the odds for a household in a rural area.   It was revealed that households that are poor are 49% times more likely to walk to the health facility they frequently used. The knowledge of the factors that will determine whether health care service seekers in a developing region will want to walk or not will assist government in the planning and provision of health facilities.

scholarly journals The Direct Health Facility Financing Impact on Financial Management in Kaliua District Council, Tabora Tanzania

2021 ◽  
Vol 7 (1) ◽  
pp. 1
Author(s):  
Batamaga Akimu Kajuni ◽  
Deogratias Faustine Mpenzi
Keyword(s):  
Health Services ◽  
Health Facility ◽  
Financial Management ◽  
Planning Process ◽  
Health Facilities ◽  
Health Services Delivery ◽  
Services Delivery ◽  
Primary Health ◽  
District Council ◽  
Primary Health Facilities

This study assessed the implementation of Direct Health Facility Financing (DHFF) on financial management among primary health facilities of Kaliua District Council. The assessment conducted because Kaliua District is the one among 184 councils where the government introduced DHFF; the study adopted case study design whereby, both qualitative and quantitative approaches were used. A structured questionnaire, Interview, FDGs, Documentary review were used in obtaining data which were classified into planning process, rate of fund utilization, adherence to financial management guidelines and perceptions of employees on fund utilization which were administered to 238 respondents who sampled through simple random and purposeful sampling techniques. Data analysed using excel and SPSS for quantitative data and content analysis for qualitative data.Study revealed that, planning process work in excellent way (72.9%); utilization capacity of funds disbursed has been acknowledged at 70%; Fund utilization perceived positively impacting on the quality of health services delivery like availability of medicines and medical equipment in health facilities unlike the time before DHFF. Financial and procurement guidelines to some extent are adhered for about 50%. However, study observed some problems like lack of funds to facilitate HFGCs’ activities, late disbursement of funds that affected utilization. Conclusively based on findings, financial management at health facilities is effective as it attributed to significantly positive impacts on general improvement of health services delivery in public primary health facilities.

scholarly journals Heterogeneity in Average Cost per Patient with type 2 Diabetes at Primary Health Facilities in Mexico: Comparing Comprehensive Diabetes Management Medical Offices with General Practice

2020 ◽  
Author(s):  
M. Arantxa Colchero ◽  
Rousellinne Gómez ◽  
Ruy López-Ridaura ◽  
Daniel López-Hernández ◽  
Iyari Sánchez-Díaz ◽  
...  
Keyword(s):  
General Practice ◽  
Diabetes Care ◽  
Diabetes Management ◽  
Unit Cost ◽  
Health Facilities ◽  
Patient Knowledge ◽  
Factors Associated ◽  
Unit Costs ◽  
Primary Health ◽  
Primary Health Facilities

Abstract Background. Despite the high health and financial burden imposed by diabetes in Mexico, few studies have estimated the cost per patient treated. The objective of this study was to estimate the average annual cost per patient (unit cost) with diabetes among 60 primary health facilities in Mexico comparing comprehensive diabetes management medical offices (MIDE) and those from general practice (Non-MIDE). Methods. We described the variation in unit costs across these two types of medical offices and explored factors associated. Unit costs were the sum of staff, medications, laboratory tests, and equipment. We show descriptive statistics to analyze the heterogeneity of unit costs, and the distribution of total costs by input and the distribution of staff costs by personnel all by medical office. We estimated a multivariate linear regression model to explore factors associated with the unit costs. Results. Unit costs vary from $267.2 USD in Non-MIDE offices to $410.6 for MIDE. Unit costs were negatively associated with scale, Non-MIDE offices, medical competence, patient knowledge of diabetes and positively associated with comorbidities. Conclusions. Results from this study might help design more efficient programs for diabetes care in primary health facilities to reduce the burden of diabetes in the system. Investing in staff training and educational interventions to increase patient knowledge of diabetes could be promising interventions to reduce diabetes care costs in primary care settings.

scholarly journals Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

2020 ◽  
Author(s):  
Bénédicte Razafinjato ◽  
Luc Rakotonirina ◽  
Jafeta Benony Andriantahina ◽  
Laura F. Cordier ◽  
Randrianambinina Andriamihaja ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Community Health ◽  
Access To Health Care ◽  
Care Delivery ◽  
Local Level ◽  
Scale Up ◽  
P Value ◽  
The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

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