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Amani DE, Ndumwa HP, Ngowi JE, Njiro BJ, Munishi C, Mboya EA, Mloka D, Kikula AI, Balandya E, Ruggajo P, Kessy AT, Kitambala E, Kapologwe N, Kengia JT, Kiologwe J, Ubuguyu O, Salum B, Kamuhabwa A, Ramaiya K, Sunguya BF. National Non-Communicable Diseases Conferences- A Platform to Inform Policies and Practices in Tanzania. Ann Glob Health 2024; 90:18. [PMID: 38463453 PMCID: PMC10921961 DOI: 10.5334/aogh.4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/03/2024] [Indexed: 03/12/2024] Open
Abstract
Background Non-communicable diseases (NCDs) arise from diverse risk factors with differences in the contexts and variabilities in regions and countries. Addressing such a complex challenge requires local evidence. Tanzania has been convening stakeholders every year to disseminate and discuss scientific evidence, policies, and implementation gaps, to inform policy makers in NCDs responses. This paper documents these dissemination efforts and how they have influenced NCDs response and landscape in Tanzania and the region. Methods Desk review was conducted through available MOH and conference organizers' documents. It had both quantitative and qualitative data. The review included reports of the four NCDs conferences, conference organization, and conduct processes. In addition, themes of the conferences, submitted abstracts, and presentations were reviewed. Narrative synthesis was conducted to address the objectives. Recommendations emanated from the conference and policy uptake were reviewed and discussed to determine the impact of the dissemination. Findings Since 2019, four theme-specific conferences were organized. This report includes evidence from four conferences. The conferences convened researchers and scientists from research and training institutions, implementers, government agencies, and legislators in Tanzania and other countries within and outside Africa. Four hundred and thirty-five abstracts were presented covering 14 sub-themes on health system improvements, financing, governance, prevention intervention, and the role of innovation and technology. The conferences have had a positive effect on governments' response to NCDs, including health care financing, NCDs research agenda, and universal health coverage. Conclusion The National NCDs conferences have provided suitable platforms where stakeholders can share, discuss, and recommend vital strategies for addressing the burden of NCDs through informing policies and practices. Ensuring the engagement of the right stakeholders, as well as the uptake and utilization of the recommendations from these platforms, remains crucial for addressing the observed epidemiological transition in Tanzania and other countries with similar contexts.
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Affiliation(s)
- Davis E. Amani
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Harrieth P. Ndumwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Jackline E. Ngowi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Erick A. Mboya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Doreen Mloka
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Amani I. Kikula
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Paschal Ruggajo
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
- Ministry of Health, P O Box 743 Dodoma, Tanzania
| | - Anna T. Kessy
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emilia Kitambala
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Ntuli Kapologwe
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | - James T. Kengia
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | | | | | - Bakari Salum
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Kaushik Ramaiya
- Tanzania Non-Communicable Diseases Alliance, P O Box 65201 Dar es salaam, Tanzania
- Tanzania Diabetes Association, P O Box 65201 Dar es salaam, Tanzania
- Shree Hindu Mandal Hospital, P O Box 581 Dar es salaam, Tanzania
| | - Bruno F. Sunguya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
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Njiro BJ, Ngowi JE, Ndumwa HP, Amani D, Munishi C, Mloka D, Balandya E, Rugajo P, Kessy AT, Ubuguyu O, Salum B, Kamuhabwa A, Ramaiya K, Sunguya BF, Mboya EA, Kikula AI, Kitambala E, Kiologwe J, Kengia JT, Kapologwe N. Non-communicable Diseases Week: Best Practices in Addressing the NCDs Burden from Tanzania. Ann Glob Health 2023; 89:89. [PMID: 38107601 PMCID: PMC10723012 DOI: 10.5334/aogh.4116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Five million people die every year from non-communicable diseases (NCDs) globally. In Tanzania, more than two-thirds of deaths are NCD-related. The country is investing in preventive and advocacy activities as well as interventions to reduce the burden. Of particular interest, the Ministry of Health (MoH) commemorates NCDs' week using a multisectoral and multi-stakeholders' approach. This paper highlights activities conducted during NCDs week with the aim of sharing lessons for other countries with similar context and burdens. Methods A thorough review of official reports and the national strategic plans for NCDs was done including the 2020 and 2021 National NCDs' week reports, the National Strategic Plan for NCDs 2015-2020, and the National NCDs agenda. Findings NCDs week is commemorated annually throughout the country involving the five key activities. First, community awareness and participation are encouraged through media engagement and community-based preventive and advocacy activities. Second, physical activities and sports festivals are implemented with a focus on developing and renovating infrastructures for sports and recreation. Third, health education is provided in schools to promote healthy behaviors for secondary school adolescents in transition to adulthood. Fourth, health service provision and exhibitions are conducted involving screening for hypertension, diabetes, obesity, alcohol use, and physical activities. The targeted screening of NCDs identified 10% of individuals with at least one NCD in 2020. In 2021, a third of all screened individuals were newly diagnosed with hypertension, and 3% were found to have raised blood glucose levels. Fifth, the national NCDs scientific conferences conducted within the NCDs week provide an avenue for stakeholders to discuss scientific evidence related to NCDs and recommend strategies to mitigate NCDs burden. Conclusion The initiation of NCDs week has been a cornerstone in advocating for NCDs control and prevention in the country. It has created awareness on NCDs, encourage healthy lifestyles and regular screening for NCDs. The multi-stakeholder and multi-sectoral approaches have made the implementation of the mentioned activities feasible and impactful. This has set an example for the united efforts toward NCD control and prevention at national, regional, and global platforms while considering contextual factors during adoption and implementation.
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Affiliation(s)
- Belinda J. Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jackline E. Ngowi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Harrieth P. Ndumwa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Amani
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Mloka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Rugajo
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna T. Kessy
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Bakari Salum
- President’s Office Regional Administration and Local Government, Tanzania
| | - Appolinary Kamuhabwa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kaushik Ramaiya
- Tanzania Non-Communicable Diseases Alliance, Tanzania
- Tanzania Diabetes Association, Tanzania
| | - Bruno F. Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | - James T. Kengia
- President’s Office Regional Administration and Local Government, Tanzania
| | - Ntuli Kapologwe
- President’s Office Regional Administration and Local Government, Tanzania
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Ndumwa HP, Amani DE, Ngowi JE, Njiro BJ, Munishi C, Mboya EA, Mloka D, Kikula AI, Balandya E, Ruggajo P, Kessy AT, Kitambala E, Kapologwe N, Kengia JT, Kiologwe J, Ubuguyu O, Salum B, Kamuhabwa A, Ramaiya K, Sunguya BF. Mitigating the Rising Burden of Non-Communicable Diseases through Locally Generated Evidence-Lessons from Tanzania. Ann Glob Health 2023; 89:77. [PMID: 38025921 PMCID: PMC10655751 DOI: 10.5334/aogh.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background The burden of Non-Communicable Diseases (NCDs) is rapidly increasing globally, and low- and middle-income countries (LMICs) bear the brunt of it. Tanzania is no exception. Addressing the rising burden of NCDs in this context calls for renewed efforts and commitment by various stakeholders. This paper highlights local initiatives and strategies to combat NCDs in Tanzania and provides lessons for countries with similar contexts. Methods We reviewed published and grey literature and conducted policy analysis on NCDs in Tanzania to examine the burden of NCDs and the national response addressing it. The documents included National NCD strategic plans, NCD research agenda, and reports from the World Diabetes Foundation and the World Health Organization. Moreover, a scoping review of ongoing NCD activities and programs in other countries was also conducted to supplement the evidence gathered. Results The rising burden of NCDs as a result of the epidemiological transition in Tanzania called for the launching of a dedicated National NCD Control and Prevention Program. The Ministry of Health collaborates with local, national, and international partners on NCD prevention and curative strategies. This led to the development of important guidelines and policies on NCDs, including strengthening the capacity of health facilities and healthcare workers, increased community engagement and awareness of NCDs, and increased advocacy for more resources in NCD initiatives. Strong governmental commitment has been vital; this is demonstrated by a renewed commitment to the fight through national NCD week and related advocacy activities conducted annually. To ensure multi-stakeholders' engagement and political commitment, all these activities are coordinated at the Prime Minister's office and provide strong lessons for countries with contexts similar to Tanzania. Conclusion Multi-stakeholders' engagement, innovative approaches, and coordinated governmental efforts to address NCDs have shone a light on addressing the burden of NCDs and may be sustainable if aligned with locally available resources. Such initiatives are recommended for adoption by other nations to address the burdens of NCDs.
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Affiliation(s)
- Harrieth P. Ndumwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Davis E. Amani
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Jackline E. Ngowi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Erick A. Mboya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Doreen Mloka
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Amani I. Kikula
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Paschal Ruggajo
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
- Ministry of Health, P O Box 743, Dodoma, Tanzania
| | - Anna T. Kessy
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emilia Kitambala
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Ntuli Kapologwe
- President’s Office Regional Administration and Local Government, P O Box, 1923 Dodoma, Tanzania
| | - James T. Kengia
- President’s Office Regional Administration and Local Government, P O Box, 1923 Dodoma, Tanzania
| | | | | | - Bakari Salum
- President’s Office Regional Administration and Local Government, P O Box, 1923 Dodoma, Tanzania
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Kaushik Ramaiya
- Tanzania Non-Communicable Diseases Alliance, P O Box 65201, Dar es salaam, Tanzania
- Tanzania Diabetes Association, P O Box 65201, Dar es salaam, Tanzania
- Shree Hindu Mandal Hospital, P O Box 581, Dar es salaam, Tanzania
| | - Bruno F. Sunguya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
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Ngowi JE, Munishi C, Ndumwa HP, Njiro BJ, Amani DE, Mboya EA, Mloka D, Kikula AI, Balandya E, Ruggajo P, Kessy AT, Kitambala E, Kapologwe N, Kengia JT, Kiologwe J, Ubuguyu O, Salum B, Kamuhabwa A, Ramaiya K, Sunguya BF. Efforts to Address the Burden of Non-Communicable Diseases Need Local Evidence and Shared Lessons from High-Burden Countries. Ann Glob Health 2023; 89:78. [PMID: 38025922 PMCID: PMC10655753 DOI: 10.5334/aogh.4118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Jackline E. Ngowi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Harrieth P. Ndumwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Davis E. Amani
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Erick A. Mboya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Doreen Mloka
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Amani I. Kikula
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Paschal Ruggajo
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
- Ministry of Health, P O Box 743 Dodoma, Tanzania
| | - Anna T. Kessy
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emilia Kitambala
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Ntuli Kapologwe
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | - James T. Kengia
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | | | | | - Bakari Salum
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Kaushik Ramaiya
- Tanzania Non-Communicable Diseases Alliance, P O Box 65201 Dar es salaam, Tanzania
- Tanzania Diabetes Association, P O Box 65201 Dar es salaam, Tanzania
- Shree Hindu Mandal Hospital, P O Box 581 Dar es salaam, Tanzania
| | - Bruno F. Sunguya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
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Kengia JT, Kalolo A, Barash D, Chwa C, Hayirli TC, Kapologwe NA, Kinyaga A, Meara JG, Staffa SJ, Zanial N, Alidina S. Research capacity, motivators and barriers to conducting research among healthcare providers in Tanzania's public health system: a mixed methods study. Hum Resour Health 2023; 21:73. [PMID: 37670321 PMCID: PMC10478476 DOI: 10.1186/s12960-023-00858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Building health research capacity in low- and middle-income countries is essential to achieving universal access to safe, high-quality healthcare. It can enable healthcare workers to conduct locally relevant research and apply findings to strengthen their health delivery systems. However, lack of funding, experience, know-how, and weak research infrastructures hinders their ability. Understanding research capacity, engagement, and contextual factors that either promote or obstruct research efforts by healthcare workers can inform national strategies aimed at building research capacity. METHODS We used a convergent mixed-methods study design to understand research capacity and research engagement of healthcare workers in Tanzania's public health system, including the barriers, motivators, and facilitators to conducting research. Our sample included 462 randomly selected healthcare workers from 45 facilities. We conducted surveys and interviews to capture data in five categories: (1) healthcare workers research capacity; (2) research engagement; (3) barriers, motivators, and facilitators; (4) interest in conducting research; and (5) institutional research capacity. We assessed quantitative and qualitative data using frequency and thematic analysis, respectively; we merged the data to identify recurring and unifying concepts. RESULTS Respondents reported low experience and confidence in quantitative (34% and 28.7%, respectively) and qualitative research methods (34.5% and 19.6%, respectively). Less than half (44%) of healthcare workers engaged in research. Engagement in research was positively associated with: working at a District Hospital or above (p = 0.006), having a university degree or more (p = 0.007), and previous research experience (p = 0.001); it was negatively associated with female sex (p = 0.033). Barriers to conducting research included lack of research funding, time, skills, opportunities to practice, and research infrastructure. Motivators and facilitators included a desire to address health problems, professional development, and local and international collaborations. Almost all healthcare workers (92%) indicated interest in building their research capacity. CONCLUSION Individual and institutional research capacity and engagement among healthcare workers in Tanzania is low, despite high interest for capacity building. We propose a fourfold pathway for building research capacity in Tanzania through (1) high-quality research training and mentorship; (2) strengthening research infrastructure, funding, and coordination; (3) implementing policies and strategies that stimulate engagement; and (4) strengthening local and international collaborations.
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Affiliation(s)
- James T Kengia
- Department of Health, Nutrition Services and Social Welfare, The President's Office Regional Administration and Local Government, P.O Box 1923, Dodoma, Tanzania.
| | - Albino Kalolo
- Center for Reforms, Innovation, Health Policies and Implementation Research, Dodoma, Tanzania
- Department of Public Health, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | | | - Cindy Chwa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Tuna Cem Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Ntuli A Kapologwe
- Department of Health, Nutrition Services and Social Welfare, The President's Office Regional Administration and Local Government, P.O Box 1923, Dodoma, Tanzania
| | - Ally Kinyaga
- Center for Reforms, Innovation, Health Policies and Implementation Research, Dodoma, Tanzania
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Steven J Staffa
- Department of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
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Mgongo MB, Manongi RN, Mboya IB, Ngocho JS, Amour C, Mtei M, Bilakwate JS, Nyaki AY, George JM, Leyaro BJ, Farah A, Kengia JT, Tinuga F, Bakari AH, Kirakoya FB, Araya A, Kapologwe NA, Msuya SE. A Qualitative Study on Barriers to COVID-19 Vaccine Uptake among Community Members in Tanzania. Vaccines (Basel) 2023; 11:1366. [PMID: 37631934 PMCID: PMC10458528 DOI: 10.3390/vaccines11081366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023] Open
Abstract
The use of vaccines is one of the key tools in reversing the COVID-19 pandemic; however, various reports reported the low uptake of the vaccines. This study explored the barriers to the COVID-19 vaccine uptake among community members in Tanzania. A qualitative explorative study was conducted in December 2021 and April 2022 in eight regions of Tanzania. Focus group discussions (FGDs) and in-depth interviews (IDIs) were the methods of data collection. A total of 48 FGDs and 32 IDIs were conducted. Participants were aware of the COVID-19 disease and vaccines. The barriers to the COVID-19 vaccine non-uptake included receiving contradicting statements from top government leaders, vaccine preceded the education, myths towards vaccines, the presence of different types of vaccines, the process of getting the vaccine, the influence of social media and random people from the community, and vaccine conflicting religious beliefs. Despite being aware of the vaccine, the uptake of the COVID-19 vaccine is still low. Interventions that focus on increasing community knowledge about COVID-19 vaccines and addressing myths about the vaccines are needed.
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Affiliation(s)
- Melina Bernard Mgongo
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Rachel N. Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Innocent B. Mboya
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
- Department of Translational Medicine, Lund University, 214 28 Malmo, Sweden
| | - James S. Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Caroline Amour
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Monica Mtei
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WCIE 7HT, UK
| | - Julieth S. Bilakwate
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Ahmed Yusuph Nyaki
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Johnston M. George
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Beatrice J. Leyaro
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
| | - Amina Farah
- Joint Malaria Program, Kilimanjaro Christian Medical Centre, Moshi P.O. Box 3010, Tanzania
| | - James T. Kengia
- President’s Office—Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (J.T.K.); (N.A.K.)
| | - Florian Tinuga
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma P.O. Box 743, Tanzania;
| | - Abdalla H. Bakari
- School of Natural Science, The State University of Zanzibar, Tunguu P.O. Box 146, Tanzania;
| | - Fatimata B. Kirakoya
- United Nations Children Fund (UNICEF), Dar es Salaam P.O. Box 4076, Tanzania; (F.B.K.); (A.A.)
| | - Awet Araya
- United Nations Children Fund (UNICEF), Dar es Salaam P.O. Box 4076, Tanzania; (F.B.K.); (A.A.)
| | - Ntuli A. Kapologwe
- President’s Office—Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (J.T.K.); (N.A.K.)
| | - Sia E. Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania; (R.N.M.); (I.B.M.); (J.S.N.); (C.A.); (M.M.); (J.S.B.); (A.Y.N.); (J.M.G.); (B.J.L.); (S.E.M.)
- Community Health Department, KCMC Hospital, Moshi P.O. Box 3010, Tanzania
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Munishi C, Mateshi G, Mlunde LB, Njiro BJ, Ngowi JE, Kengia JT, Kapologwe NA, Deng L, Timbrell A, Kitinya W, Pembe AB, Sunguya BF. Community-based transport system in Shinyanga, Tanzania: A local innovation averting delays to access health care for maternal emergencies. PLOS Glob Public Health 2023; 3:e0001487. [PMID: 37531348 PMCID: PMC10395988 DOI: 10.1371/journal.pgph.0001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
In achieving the sustainable development goal 3.1, Tanzania needs substantial investment to address the three delays which responsible for most of maternal deaths. To this end, the government of Tanzania piloted a community-based emergency transport intervention to address the second delay through m-mama program. This study examined secondary data to determine the cost-effectiveness of this intervention in comparison to the standard ambulance system alone. The m-mama program was implemented in six councils of Shinyanga region. The m-mama program data analyzed included costs of referral services using the Emergency Transportation System (EmTS) compared with the standard ambulance system. Analysis was conducted using Microsoft Excel, whose data was fed into a TreeAge Pro Healthcare 2022 model. The cost and effectiveness data were discounted at 5% to make a fair comparison between the two systems. During m-mama program implementation a total of 989 referrals were completed. Of them, 30.1% used the standard referral system using ambulance, while 69.9% used the EmTS. The Emergency transport system costed USD 170.4 per a completed referral compared to USD 472 per one complete referral using ambulance system alone. The introduction of m-mama emergency transportation system is more cost effective compared to standard ambulance system alone in the context of Shinyanga region. Scaling up of similar intervention to other regions with similar context and burden of maternal mortality may save cost of otherwise normal emergency ambulance system. Through lessons learned while scaling up, the intervention may be improved and tailored to local challenges and further improve its effectiveness.
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Affiliation(s)
- Castory Munishi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gilbert Mateshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda B Mlunde
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jackline E Ngowi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | - Ntuli A Kapologwe
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | | | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno F Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Njiro BJ, Ngowi JE, Mlunde L, Munishi C, Kapologwe N, Kengia JT, Deng L, Timbrell A, Kitinya WJ, Sunguya BF. Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania. PLOS Glob Public Health 2023; 3:e0002097. [PMID: 37343036 DOI: 10.1371/journal.pgph.0002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
Maternal mortality comprises about 10% of all deaths among women of reproductive age (15-49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder' involvement during program implementation.
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Affiliation(s)
- Belinda J Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jackline E Ngowi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda Mlunde
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ntuli Kapologwe
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | | | - Bruno F Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mtei M, Mboya IB, Mgongo M, Manongi R, Amour C, Bilakwate JS, Nyaki AY, Ngocho J, Jonas N, Farah A, Amour M, Kalolo A, Kengia JT, Tinuga F, Ngalesoni F, Bakari AH, Kirakoya FB, Araya A, Kapologwe NA, Msuya SE. Confidence in COVID-19 vaccine effectiveness and safety and its effect on vaccine uptake in Tanzania: A community-based cross-sectional study. Hum Vaccin Immunother 2023; 19:2191576. [PMID: 37017234 PMCID: PMC10088920 DOI: 10.1080/21645515.2023.2191576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
COVID-19 is a major public health threat associated with increased disease burden, mortality, and economic loss to countries and communities. Safe and efficacious COVID-19 vaccines are key in halting and reversing the pandemic. Low confidence in vaccines has been one of the factors leading to hesitancy. We aimed to assess the COVID-19 vaccine confidence (safety and effectiveness), associated factors, and its effects on vaccine uptake among general community members in Tanzania. This was a community-based cross-sectional survey conducted from December 2021 to April 2022 in six regions of Tanzania mainland and two regions in Zanzibar. Participants were interviewed using an electronic questionnaire. Multiple logistic regression models estimated odds ratios (ORs) and 95% confidence interval (CI) for factors associated with vaccine confidence. All analyses were performed using SPSS version 25.0. The study enrolled 3470 general Tanzanian community members; their mean age was 40.3 (standard deviation ±14.9) years, and 34% were males. The proportion of COVID-19 vaccine confidence was 54.6%. Geographical region, residence area, COVID-19 disease risk perception, and good knowledge of COVID-19 vaccines were significantly associated with COVID-19 vaccine confidence. Confidence in COVID-19 vaccines was associated with over three times higher odds of vaccine uptake. Confidence in COVID-19 vaccines was low in Tanzania. Innovative community engagement strategies and region-specific interventions are needed to improve comprehensive knowledge and address community perceptions and attitudes toward COVID-19 vaccines.
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Affiliation(s)
- Monica Mtei
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Faculty of epidemiology and population health, London School of Hygiene and Tropical Medicine, London, UK
| | - Innocent B Mboya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Melina Mgongo
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rachel Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Caroline Amour
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Julieth S Bilakwate
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ahmed Y Nyaki
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - James Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Norman Jonas
- Internal Medicine Department, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Amina Farah
- Joint Malaria Program, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Maryam Amour
- Department of community health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| | - James T Kengia
- Department of health, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Florian Tinuga
- Ministry of Health, Immunization and Vaccine Development Department, Dodoma, Tanzania
| | - Frida Ngalesoni
- Department of Health, African Medical and Research Foundation, Dar-es-salaam, Tanzania
| | - Abdalla H Bakari
- School of Natural Science, The State University of Zanzibar, Zanzibar, Tanzania
| | | | - Awet Araya
- Department of Health, UNICEF, Tanzania Office, Dar-es-salaam, Tanzania
| | - Ntuli A Kapologwe
- Department of health, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Community Health Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Jiyenze MK, Sirili N, Ngocho JS, Kikula A, Chikoti B, Kapologwe N, Kengia JT. Strengthening health management, leadership, and governance capacities: What are the actual training needs in Tanzania? Health Sci Rep 2023; 6:e1158. [PMID: 36949870 PMCID: PMC10027058 DOI: 10.1002/hsr2.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/24/2023] Open
Abstract
Background and Aim Effective management, leadership, and governance (MLG) contribute to improved population health outcomes. However, weak management, leadership, and governance capacity continue to haunt many health systems in low- and-middle-income countries (LMICs). Capacity strengthening through training of health system managers is among the strategies to address the latter challenge. However, the actual needs for MLG training remain unestablished in many LMICs. The main objective of this study was to assess the training needs for MLG among health managers in Tanzania Mainland. Methods We employed a mixed methods approach and convergent mixed methods study design to establish MLG training needs among health managers. In March 2019, quantitative data were collected by administering a questionnaire to a quantitative sample of 156 health managers working in 14 councils and seven regions. We used semi-structured interviews to collect qualitative data from a qualitative sample of 35 health managers. We used descriptive statistical technique and thematic analysis to analyse quantitative and qualitative data, respectively. Results The main findings of this study show that: 152 (97%) health managers and all 35 interviewees said that there was a need for training health managers on MLG; 31 out of the 33 proposed MLG competencies were rated as important by the health managers; and a list of 35 general topics and 19 priority topics were suggested by the health managers for inclusion in future MLG training. Conclusion Our research has generated useful empirical evidence indicating the needs for training health managers on MLG in terms of expressed needs, important competencies, and topics. Policymakers and training developers should use the evidence to develop training programs to address identified needs. Future training needs studies on management and leadership should use observational and diary methods to collect data on the competencies of health managers.
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Affiliation(s)
- Mwandu K. Jiyenze
- Centre for Educational Development in Health Arusha (CEDHA)ArushaTanzania
| | - Nathanael Sirili
- Muhimbili University of Health and Allied Sciences (MUHAS)Dar es SalaamTanzania
| | - James S. Ngocho
- Department of Epidemiology and Applied BiostatisticsKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Amani Kikula
- Muhimbili University of Health and Allied Sciences (MUHAS)Dar es SalaamTanzania
| | | | - Ntuli Kapologwe
- President's Office‐Regional Administration and Local Government (PORALG)DodomaTanzania
| | - James T. Kengia
- President's Office‐Regional Administration and Local Government (PORALG)DodomaTanzania
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Ruhago GM, John MB, Ngalesoni FN, Msasi D, Kapologwe N, Kengia JT, Bukundi E, Ndakidemi R, Tukai MA. Understanding the implication of direct health facility financing on health commodities availability in Tanzania. PLOS Glob Public Health 2023; 3:e0001867. [PMID: 37155608 PMCID: PMC10166559 DOI: 10.1371/journal.pgph.0001867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
The Government of Tanzania (GoT) has in the last decade made progress in strengthening the health system financing with progress towards Universal Health Coverage (UHC). The major reforms includes development of the health financing strategy, reforming the Community Health Fund (CHF) and introduction of the Direct Health Facility Financing (DHFF). DHFF was introduced in all district councils in the 2017/18 financial year. One of the anticipated goals of DHFF is to improve availability of health commodities. The objective of this study is to assess the effect of DHFF in improving the availability of health commodities in primary health care facilities. This study employed cross sectional study design, using quantitative techniques to analyze data related to expenditures and availability of health commodities at the primary health care facilities in Tanzania mainland. Secondary data was extracted from Electronic Logistics Management Information System (eLMIS) and Facility Financial Accounting and Reporting System (FFARS). Descriptive analysis was used to summarize the data using Microsoft Excel (2021) and inferential analysis was done using Stata SE 16.1. There has been an increase in allocation of funds for health commodities over the past three years. The Health Basket Funds (HBFs) accounted for an average of 50% of all health commodities expenditures. The complimentary funds (user fees and insurance) contributed about 20%, which is less than the 50% required by the cost sharing guideline. There is potentiality in DHFF improving visibility and tracking of health commodities funding. Implementation of DHFF has increased the amount of funding for health commodities at health facilities. The visibility and tracking of health commodity funding has improved. There is a scope of increasing health commodity funds at health facilities since the expenditures on health commodities is lower than what is indicated in the cost sharing collection and use guideline.
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Affiliation(s)
- George M Ruhago
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael B John
- USAID Global Health Supply Chain Program Technical Assistance, Dar es Salaam, Tanzania
| | - Frida N Ngalesoni
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daudi Msasi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Ntuli Kapologwe
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Elias Bukundi
- Department of Epidemiology and Biostatics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Regina Ndakidemi
- Tanzania Public Sector Systems Strengthening Plus (PS3+) Project, Dar Es Salaam, Tanzania
| | - Mavere A Tukai
- USAID Global Health Supply Chain Program Technical Assistance, Dar es Salaam, Tanzania
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12
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Kesale AM, Jiyenze MK, Katalambula L, Kinyaga AY, Sirili N, Ngocho JS, Ruhago G, Kikula A, Kapologwe NA, Kengia JT. Perceived performance of health facility governing committees in overseeing healthcare services delivery in primary health care facilities in Tanzania. Int J Health Plann Manage 2023; 38:239-251. [PMID: 36129408 DOI: 10.1002/hpm.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 01/07/2023] Open
Abstract
Health Facility Governing Committees (HFGCs) play a vital role in overseeing health services delivery in the primary health care system. However, despite their existence in Tanzania hiccups remain reported on the quality of health services delivered in primary health care facilities. The latter poses a question on the performance of HFGCs in overseeing the services delivery at the primary health facilities. This study sought to assess the perceived performance of the HFGCs and the associated factors in overseeing the healthcare services delivery at the primary health facilities in Tanzania. A cross-sectional study was conducted in five regions of Tanzania: Mwanza, Dar Es Salaam, Kilimanjaro, Pwani, and Arusha. A self-administered questionnaire containing structured questions was used to gather information from randomly selected 574 HFGC members. Data were analyzed descriptively and the binary logistic regression model was used to determine factors associated with the perceived performance. Half (50.52%) of the HFGCs members perceived themselves to have good performance. Furthermore, only 51.05% of all the participants had received any form of health management and governance training whereby about two-thirds had received training for only 1 day. The main factors associated with the perceived low performance of the HFGCs members were age, level of education and duration served in the HFGC. A low level of education was associated with the poor perceived performance of the HFGC (AOR 0.36 [CI: 0.23-0.55]). Similarly with increasing age, the odds of good-perceived performance lowered (AOR 0.26 [CI: 0.13, 0.55]). Serving as a HFGC member for less than 1 year was associated with poor perceived performance (AOR 0.40 [CI: 0.17, 0.95]). From these findings, it is recommended that the criteria for recruitment of HFGC members should be revisited. Furthermore, a qualitative study to explore contextual factors influencing the perforce of HFGCs is recommended.
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Affiliation(s)
- Anosisye M Kesale
- Department of Local Government Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.,Centre for Educational Development in Health Arusha (CEDHA), Arusha, Tanzania
| | - Mwandu Kini Jiyenze
- Centre for Educational Development in Health Arusha (CEDHA), Arusha, Tanzania.,Center for Reforms, Innovation, Health Policies and Implementation Research (CeRIHI), Dodoma, Tanzania
| | - Leonard Katalambula
- Department of Public Health and Community Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Ally Y Kinyaga
- Center for Reforms, Innovation, Health Policies and Implementation Research (CeRIHI), Dodoma, Tanzania
| | - Nathanael Sirili
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es salaam, Tanzania
| | - James S Ngocho
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es salaam, Tanzania
| | - Amani Kikula
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es salaam, Tanzania
| | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutrition Services, President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James T Kengia
- Department of Health, Social Welfare and Nutrition Services, President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
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Ruhago GM, Ngalesoni FN, Kapologwe NA, Kengia JT, Ngocho J, Kabusi SM, Kalolo A, Kitali EJ, Rwamiago E, Mtei G. Strengthening financial management systems at primary health care: Performance assessment of the Facility Financial Accounting and Reporting System (FFARS) in Tanzania. Front Health Serv 2022; 2:787940. [PMID: 36925885 PMCID: PMC10012670 DOI: 10.3389/frhs.2022.787940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/18/2022] [Indexed: 01/11/2023]
Abstract
Background Universal coverage remains a challenging pursuit around the world, even among the highest-income countries. Strengthening financial management capacity is essential towards attaining the three universal health coverage (UHC) goals, namely, expanded coverage, quality service, and financial protection. In this regard, Tanzania introduced the Facility Financial Accounting and Reporting System (FFARS) in line with the introduction of the Direct Health Facility Financing (DHFF) initiative in primary health care (PHC) in 2017-2018. We aim to assess the functionality of the FFARS in management, accounting, and reporting funds received and disbursed in the stride forward strengthening public financial management in PHC facilities towards UHC. Methods The study applied implementation research using a concurrent convergent mixed-methods design to assess sources of revenue, expenditure priorities, and changes of revenues and to explore the usability and benefits of FFARS in improving facility finance and reporting systems in more than 5,000 PHC facilities in Tanzania. Quantitative methods assessed the changes in revenues and expenditure between the financial years (FYs) 2017-2018 and 2018-2019, while the qualitative part explored the usability and the benefits FFARS offers in improving facility finances and reporting systems. Data analysis involved a thematic and descriptive analysis for qualitative and quantitative data, respectively. Results Of the 5,473 PHC facilities, 88% were in rural areas; however, the annual average revenue was higher in urban facilities in FYs 2017-2018 and 2018-2019. Overall, district hospitals showed an increase whereas health centers reported a decline of more than 40% in revenue. The user fee was the predominant source of revenue, particularly in urban facilities, while revenue from health insurance was not among the top three highest sources of revenue. Expenditure priorities leaned more towards drugs and supplies (25%) followed by allowances and training (21%); these did not differ by facility geographies. In health centers, expenditure on facility infrastructure was predominant. Key Informant Interviews revealed an overall satisfaction and positive experiences related to the system. Conclusion The implementation of FFARS in Tanzania demonstrated its high potential in improving facility financial management, including its ability to track revenue and expenditure at PHC facilities. Staffing shortages, ICT infrastructure, and limited opportunities for capacity building could be the limiting factors to reaching the potential of the implementation of FFARS and the attainment of its full impact on Tanzania's pursuit for UHC.
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Affiliation(s)
- George M Ruhago
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Frida N Ngalesoni
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.,Amref Health Africa, Dar Es Salaam, Tanzania
| | - Ntuli A Kapologwe
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stephen M Kabusi
- Department of Public Health, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Albino Kalolo
- Department of Public Health, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Erick J Kitali
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Elisa Rwamiago
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Gemini Mtei
- Abt Associates, Tanzania Public Sector Systems Strengthening Plus (PS3+) Project, Dar Es Salaam, Tanzania
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14
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Ruhago GM, Ngalesoni FN, Msasi D, Kengia JT, Mganga M, Kapologwe NA, Mtoroki M, Tukai MA. The public health sector supply chain costs in Tanzania. PLOS Glob Public Health 2022; 2:e0000960. [PMID: 36962820 PMCID: PMC10022133 DOI: 10.1371/journal.pgph.0000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/26/2022] [Indexed: 11/29/2022]
Abstract
Tanzania's supply chain system is a complicated web of integrated and vertical systems, covering essential and vertical programs health commodities, laboratory and diagnostics, equipment, and supplies. Despite significant improvement in the supply chain over the decades, the availability of medicines has remained uneven. Therefore, identifying the cost of operating the supply chain is vital to facilitate allocation of adequate finances to run the supply chain. We adopted a three-step approach to costing, which included i) identification, ii) measurement, and (iii) valuation of the resource use. Two levels of the Tanzanian supply chain system were examined to determine the cost of running the supply chain by function. These included first the Medical Stores Department (MSD) central and zonal level, secondly the health service delivery level that include National, Zonal and regional hospitals and the Primary Health Care (District Hospital, health center and Dispensary). The review adopted the health system perspective, whereby all resources consumed in delivering health commodities were considered, resource use was then classified as financial and economic costs. The costing period was an average of two financial years, 2015/16 and 2016/17. The cost data were exchanged from Tanzania Shillings to 2017 US$ and then adjusted for inflation to 2020 US$. The study used the total sales reported in audited financial accounts for throughput value. The average annual costs of running the supply chain at the central MSD was estimated at USD$ 15.5 million and US$ 4.1 million at the four sampled MSD Zonal branches. There is a wide variation in annual running costs among MSD zonal branches; the supply chain's unit cost was highest in the Dodoma zone and lowest in the Mwanza zone at 26% and 8%, respectively. When examined on a cost-per-unit basis, supply chain systems operate at sub-optimal levels at health facilities at a unit cost of 37% per unit of commodity throughput value. There are inefficiencies in supply chain financing in Tanzania. Storage costs are higher than distribution costs, this may imply some efficiency gains. MSD should employ a "just in time" inventory model, reducing the inventory holding costs, including the high-expired commodities holding charge, this could be improved by increasing the order fill rate.
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Affiliation(s)
- George M Ruhago
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frida N Ngalesoni
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daudi Msasi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Mathew Mganga
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Ntuli A Kapologwe
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | | | - Mavere A Tukai
- USAID Global Health Supply Chain Program Technical Assistance, Dar es Salaam, Tanzania
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Ruhago GM, Kapologwe NA, Ngalesoni FN, Kengia JT, Kibusi SM, Kalolo A, Kitali EJ, Mtatifikolo JD, Masuha SR, Kikula A, Mtei G. Cost-Efficiency Analysis of the Improved Web-Based Planning, Budgeting, and Reporting System (PlanRep) in Tanzania. Front Health Serv 2021; 1:787894. [PMID: 36926476 PMCID: PMC10012613 DOI: 10.3389/frhs.2021.787894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
Background Information systems offer unlimited potential for innovation and digitalization of management functions to facilitate citizen participation and improve accountability, transparency, and efficiency in government operations and service delivery. In line with this, for more than one decade, Tanzania implemented an integrated planning, budgeting, and reporting system (PlanRep) that was used to prepare plans and budgets at the local government authorities (LGAs) using a desktop application. In 2017, PlanRep was upgraded to a Web-based system to address several challenges, including poor coordination and high cost involved in the preparation of plans and budgets. However, operational evidence regarding the cost-efficiencies and benefits of shifting to Web-based PlanRep has not been explored. This study aims to address this gap by assessing efficiency gains (in terms of cost and time) of shifting to a Web-based PlanRep system as a tool for the preparation of LGA plans and budgets. Methods The study applied a retrospective before-and-after study design whereby quantitative data was used to assess the amount of time and the cost incurred by LGAs when preparing their budget 1 year before the introduction of PlanRep and 1 year after. Parallelly, qualitative data were collected through key informant interviews with selected LGA officials, Regional Secretariats (RSs), President's Office Regional Administration and Local Government (PORALG), and system end-users such as heads of health facilities and schools (primary and secondary). Secondary data was analyzed by comparing time and cost used before and after Web-based PlanRep, while thematic analysis was employed for qualitative data. Results The analysis showed a 53% reduction (from USD 3.8 million in 2017/18 to USD 1.8 million in 2018/19) in the total costs LGAs incurred during planning and budgeting after introducing the Web-based PlanRep. The main efficiency gain was related to per diem costs. The analysis also showed significant time saving from an average of 87 days in 2017/18 to only 8 days in 2018/19. PlanRep system end-users also acknowledged that the introduction of Web-based PlanRep has significantly saved their time and costs in preparation of LGA plans and budget. Conclusion The introduction of the Web-based planning, budgeting, and reporting systems has resulted in tremendous cost reduction, time savings, transparency, accountability, and workload reduction. The findings offer operational evidence to guide the implementation and scale up of similar systems in countries that share equivalent circumstances like Tanzania.
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Affiliation(s)
- George M Ruhago
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ntuli A Kapologwe
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Frida N Ngalesoni
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Amref Health Africa Tanzania, Dar es Salaam, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Stephen M Kibusi
- Department of Public Health, University of Dodoma, Dodoma, Tanzania
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Erick J Kitali
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James D Mtatifikolo
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Sutte R Masuha
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Amani Kikula
- Department of Obstetrics and Gynecologist, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gemini Mtei
- Abt Associates, Tanzania Public Sector Systems Strengthening Plus (PS3+) Project, Dar es Salaam, Tanzania
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Kapologwe NA, Meara JG, Kengia JT, Sonda Y, Gwajima D, Alidina S, Kalolo A. Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania. BMC Health Serv Res 2020; 20:218. [PMID: 32183797 PMCID: PMC7076948 DOI: 10.1186/s12913-020-5057-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). Quality health service provision together with equitable geographic access and service delivery are important components that constitute UHC. Tanzania has been investing in infrastructure development to offer essential safe surgery close to communities at affordable costs while ensuring better outcomes. This study aimed to understand the public sector's efforts to improve the infrastructure of primary health facilities between 2005 and 2019. We assessed the construction rates, geographic coverage, and physical status of each facility, surgical safety and services rendered in public primary health facilities. METHODS Data was collected from existing policy reports, the Services Availability and Readiness Assessment (SARA) tool (physical status), the Health Facility Registry (HFR), implementation reports on infrastructure development from the 26 regions and 185 district councils across the country (covering assessment of physical infrastructure, waste management systems and inventories for ambulances) and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. Data was descriptively analyzed so as to understand the distribution of primary health care facilities and their status (old, new, upgraded, under construction, renovated and equipped), and the service provided, including essential surgical services. RESULTS Of 5072 (518 are Health Centers and 4554 are Dispensaries) existing public primary health care facilities, the majority (46%) had a physical status of A (good state), 33% (1693) had physical status of B (minor renovation needed) and the remaining facilities had physical status of C up to F (needing major renovation). About 33% (1673) of all health facilities had piped water and 5.1% had landline telecommunication system. Between 2015 and August 2019, a total of 419 (8.3%) health facilities (Consisting of 350 health centers and 69 District Council Hospitals) were either renovated or constructed and equipped to offer safe surgery services. Of all Health Centers only 115 (22.2%) were offering the CEMONC services. Of these 115 health facilities, only 20 (17.4%) were offering the CEMONC services with all 9 - signal functions and only 17.4% had facilities that are offering safe blood transfusion services. CONCLUSION This study indicates that between 2015 and 2019 there has been improvement in physical status of primary health facilities as a result constructions, upgrading and equipping the facilities to offer safe surgery and related diagnostic services. Despite the achievements, still there is a high demand for good physical statuses and functioning of primary health facilities with capacity to offer essential and safe surgical services in the country also as an important strategy towards achieving UHC. This is also inline with the National Surgical, Obstetrics and Anesthesia plan (NSOAP).
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Affiliation(s)
- Ntuli A. Kapologwe
- President’s Office – Regional Administration and Local Government (Directorate of Health, Social Welfare and Nutrition Services), P.O Box 1923, Dodoma, Tanzania
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
| | - James T. Kengia
- President’s Office – Regional Administration and Local Government (Directorate of Health, Social Welfare and Nutrition Services), P.O Box 1923, Dodoma, Tanzania
| | - Yusuph Sonda
- President’s Office – Regional Administration and Local Government (Directorate of Health, Social Welfare and Nutrition Services), P.O Box 1923, Dodoma, Tanzania
| | - Dorothy Gwajima
- President’s Office – Regional Administration and Local Government (Directorate of Health, Social Welfare and Nutrition Services), P.O Box 1923, Dodoma, Tanzania
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, P.O Box 175, Ifakara, Tanzania
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