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FACTORS CONTRIBUTING TO EARLY PREGNANCIES TO GIRLS BELOW 20
YEARS IN BIHARAMULO DISTRICT
Vedastus K. Kilolonga
Masters of Health Systems Management (MHSM) (2012)
This study is on the contributing factors of early pregnancies to girls below 20 years in Biharamulo District. The main purpose of the study was to determine the factors contributing to adolescent girls to early pregnancies. The study focused to the girls’ aged between 14 – 19, years old, who were grouped into three; 14 – 15, 16 – 17 and 18 – 19 years respectively. The study population was selected purposively basing on attendances for maternal and child health clinics and included 65 adolescent pregnant teen girls only. Data collection was done through a self-administered questionnaire to the pregnant girls below 20 years. Data collected were analyzed using SPSS version 16 programme and excel findings indicating that a pregnancy among girls below 20 years in the district is alarming. The main contributing factors were mentioned to be unsafe sex (83%), single parent (83%), economic hardship (80%) followed by early marriage (70%). Most of the girls were not forced to get pregnancies they were willing to. The most age group affected was between 17 – 19 years old that was 83%. The majority of pregnant girls were from rural areas (80%) compared to urban areas 20%. No one reported to dropout from school due to pregnancy. The implications generally, impact of this problem is that it will result to low education, low income, increased number of disadvantaged children/street children, increased new HIV/AIDS and maternal and infant mortalities. It is recommended that efforts to be done to ensure that the health education is strengthened to the public on the impacts of pregnancies below 20 years old. Special programs need to be initiated to address the issues of adolescent pregnancies. Collective effort among policy makers, health workers, individuals, families and researchers are vital in fighting this problem. APPLICATION OF THE SEXUAL OFFENSE SPECIAL PROVISIONS ACT, 1998
AGAINST FEMALE GENITAL MUTILATION (FGM)
The Case of TarimeDistrict
Elias Shija Maziku
Masters of Health Systems Management (MHSM) (2012)
This study examines the application of Sexual Offences Special Provision Act of 1998, which paves the way for the contemporary existence of Female Genital Mutilation in Tarime District. It also looks into the measures taken to resolve this practice. The study was guided by the following specific objectives. Firstly to identify cultural practices which perpetuate existence of FGM. Secondly to examine the role of state and Non-State actors in the application of SOSPA against FGM. Thirdly, was to determine knowledge, attitude and Practice of SOSPA. Fourthly was to determine opinions of Tarime community members against FGM. Research was concentrated on three Wards which predominantly practice FGM and these were Turwa, Nymisangura and Nyandoto. Data were collected through questionnaire, interview and review of various documentary sources. The study found the culture of the people, the beliefs of the people concerning traditional circumcision, and ritual practices was transmitted to successive generations, thereby increasing ethnic and clan consciousness and animosity between these groups. Findings indicates that low level of education concerning anti-FGM laws in the community influence the continuation practices of female circumcision and thus contributing towards failure in the application of laws of fight the practice in the Tarime. Study also found that existence of FGM were the results of the failure on the part of the government to exercise fairness, implements its decisions, observe human rights, consult its people when formulating its plan and establish proper linkages between its various sections, also lack of commitment among government institutions. Also the study found that there is a striking lack of communication about FGM laws towards Reproductive Health education among the community, between health care providers and community, as well as within the women’s communities. Based on the above findings, study shows that there is a knowledge gap concerning laws against Female Genital Mutilation. Therefore study recommends that SOSPA should be mainstreamed in the school’s curriculum in primary, secondary and higher institution, finally the study is with opinion that there is a need for the Council and other stakeholders such as NGOs both local and international to establish special programs of education and advocacy against Female Genital Mutilation laws. DOES NATIONAL HEALTH INSURANCE MAKE A DIFFERENCE? AN
EXAMINATION OF THE EXPERIENCE OF NHIF CUSTOMERS AND NON-
CUSTOMERS
Melickzedek G. Nkini
Masters of Health Systems Management (MHSM) (2012)
This study examined customer satisfaction regarding (i) accessibility in terms of services; (ii) customer satisfaction with respect to protection from out of pocket (OPP), delay/postponements for treatment, denial or refusal to treatment for lack of money, reduced direct cost fulfilled during illnesses, coverage of benefits in respect to medical necessities (eligibility) and, (iii) quality of healthcare with regard to waiting time, doctor-patient time and drugs availability. It involved a sample of 120 respondents. Overall, on customer satisfaction, both members and non-members were dissatisfied with the status of accessibility, protection, and quality of the health services offered. Specifically, on (i) accessibility, the results did not show any differences between the members and non-members in terms of distance, time and choice for alternative care as the difference between those two groups was merely 10%, with members experiencing a lower margin compared to non-members. Regarding to (ii) protection OPP, only a difference of 4.1% was revealed, with members paying a little less compared to non-members. The question on delay or postponement of treatment data showed a difference of 3.3% between the two groups, members experiencing a lower rate, interestingly, as far as denial/refusal to treatment was concerned, both groups reported the same reading of 97% that they were not denied of services for lack of cash, while denied responses had the same reading of 3% from both groups etc. (iii) On quality of health care, findings indicated that the difference in waiting time between members and non-members was merely 1.7%; for members being slightly on the higher side, while for doctor-patient time the difference was 2.5%. The difference for services satisfaction, drug availability among the two groups was 2.5%, and the overall percentage on satisfactions reported on drug availability was 80%. Unless necessary steps are taken to improve the service delivery, the scheme will continue not making any distinction which will discourage more members in joining. TO ASSESS READINESS OF MALE INVOLVEMENT IN PMTCT SERVICE
A Case of Ruangwa District
Godfrey Amani
Masters of Health Systems Management (MHSM) (2012)
This study sought to assess readiness of male involvement in PMTCT services. The study also intended to assess male’s awareness towards PMTCT services, to determine the perceptions of males towards PMTCT services and to assess if there are any socio- design was adopted and a total of 137 respondents including 106 married pregnant women and 31 male partners were interviewed. The data collected were coded, checked for quality and analyzed using the SPSS software. The study revealed beyond reasonable doubt that readiness of male involvement in PMCTC services is still very low, as the findings indicated that majority of pregnancy women attended ANC clinics only once together with their husbands. The findings indicated that majority of pregnant women (60.4%) attended ANC clinics only once with their husbands followed by 16.0% whom did not attend any of the ANC clinics while 11.3% attended ANC clinics regularly together with their husbands. On the other hand the findings revealed that few men usually accompany their wives on visits to ANC clinics where PMCTC services are provided where by 31 married male partners were found to accompany their wives to ANC clinics compared to 106 married pregnant women who attended ANC clinics. Based on the findings, the study recommends that, for PMCTC services to be a success as far as readiness of male involvement is concerned; every member within the organization should have a clear understanding on its importance and all aspects constituting its realization. More importantly the management team which is the ‘service provider’ needs to establish such policies and ensure that they are clearly stipulated, clearly understood by all organization members/workers and supervised for better implementation. The target group should have access to instruments stipulating service guidance and service rights; this will build a good relationship and trust by customer/clients to service providers. Also there is a need for a deliberate involvement and participation of community members and other stakeholders through health education, competent and committed health facility service providers who are empowered wit knowledge, skills, and readily available working tools. STAFF RETENTION AT KALIUA HEALTH CENTER IN URAMBO DISTRICT-
Sr. Adelaida Mishoni
Masters of Health Systems Management (MHSM) (2012)
Staff retention is an area of study that can be studied from different angles. The issue in this study was to study the practice of staff retention Private Health Institutions taking Kaliua Health Center as a case study. The major and minor research questions/objectives were used to determine the appropriate methodology to determine the retention level, retention strategies, to identify the factors that promote or hinder staff retention and to suggest the possible solutions to overcome the problem at Kaliua Health Center. Data were collected through questionnaires and documentary review. Though data analysis was done manually, the collected data were sorted, processed and tabulated before analysis. The research findings revealed that, the retention practice at Kaliua Health Center had been faced with the problems like financial constraints, poor working environment, poor performance reviews and recognition and low level of career development hence has low practice of basic attractive factors for staff retention. The study also revealed that there is a need to improve staff retention program implementation in health Care Institutions so as to make it more practical. Having effective retention planning and proper utilization of resources generated will help in solving the problem and encouraging employee’s good performance in attaining the organizational goals. Finally, the paper recommends that, the general administration of the Archdiocese of Tabora should plan for means to raise the funds for the Kaliua Health Center such as internal and external projects; this is because most of the suggested measures require the hospital financial capacity improvement. Together with, human resource planning, career development and succession capacity planning should be considered. On the other side the government should have a role to assist the private health sector for providing enough funds for staff salaries and other clinical activities like training, medical supplies and infrastructure improvements so that the private health sector can properly manage its clinical services as far as the social responsibilities are concerned. ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICES REGARDING
EMERGENCY CONTRACEPTIVE PILLS TO PREVENT UNWANTED PREGNANCIES
AMONG FEMALE SECONDARY SCHOOL STUDENTS IN TANDAHIMBA DISTRICT
Isaac Katenda
Masters of Health Systems Management (MHSM) (2012)

Background: Emergency contraceptive pills (ECPs) is one of the post coital means to
prevent unwanted pregnancies once taken within 72 hours following risky for pregnancy
sexual intercourse. For young adolescents, though the risk for unplanned pregnancies
among them is high, it usually result into serious negative consequences including
unsafe abortions, psychological problems and additionally in Tanzania environment, it
leads to expulsion from school. The aim of this study was to assess the level of
knowledge, attitudes and practices regarding ECPs as the means to prevent unplanned
pregnancies among female secondary school students.
Methods: A cross sectional descriptive study was undertaken in March 2012 among
female secondary school students to assess their knowledge, attitudes and practices
regarding ECPs. A total of 420 respondents from six secondary school were randomly
selected to participate in the study. Four school matrons, six ADDO attendants and a
District reproductive and Child Health coordinator were interviewed on the situation of
ECPs use among youths and formal responses on intervening the problem of unwanted
pregnancies among female secondary school students in the area.
Results: Only 46.1% of the students had ever heard about ECPs. More than 50% of
the respondents had no correct knowledge on ECPs on the aspects of timing, dosage
side effects and efficiency of ECPs and few students (10.4%) had ever used ECPs.
Generally, the attitudes towards ECPs have been seen to be positive; there was no
official strategy to address the problem of unwanted pregnancies from both the health
and educational authority seen in place, with the lack of knowledge on ECPs reported
among school matrons and ADDOs/Pharmacies service providers.
Conclusion: To address the problem of unplanned pregnancies by the use of ECPs
among other things needs to consider raising awareness, knowledge and accessibility.
There is a need for health and education sector in district to intervene the alarming
problem of unplanned pregnancies among female secondary school students in the
District.
FACTORS CONTRIBUTING TO GENDER IMBALANCE IN LEADERSHIP
POSITIONS IN LOCAL AUTHORITIES IN TANZANIA
Irene Gilbert Chilewa
Masters of Health Systems Management (MHSM) (2012)
The purpose of the study was to determine the underlying factors contributing to persistence of gender imbalance in leadership positions in Municipal Councils. Amana hospital was selected as a case study. Specific objectives was to identify number and composition of staffs, to identify key leadership position including job specification of key leadership position, to establish the proportion of woman to men in key leadership position and to identify the reasons that attribute to the proportion of women to men in key leadership positions in the health department of Amana Municipal Council. Primary data were collected through questionnaires and interview. Secondary data were collected by reviewing various published and unpublished documents, journals and reports related to research topic. The collected data were analyzed quantitatively and qualitatively. The findings were analyzed and presented in accordance with the research objectives, as far as gender imbalance is concerned. Provision of gender knowledge of staff seems to be problem because of biasness of responsible leaders in selecting staff to attend. And few programs were conducted to train staff to attend. And few programmes were conducted to train staff on gender issues. In general, during the study most of the respondents including the administrators stated that academic qualification is one of the underlying factors that contribute to the persistence of gender imbalance in leadership positions in Amana Hospital, because the number of women at Amana hospital is larger than that of men but the percent of men with bachelor degree and masters is higher than women. Also other respondents complained on the system of training the staff in which biasness and selfishness were identified as factors to persistence of gender imbalance in leadership positions. Conclusively, there should be appropriate initiatives of upgrading women academically, gender education to all MDs and impose laws against gender imbalance and impose laws against gender imbalance to ensure that there is gender equality in leadership position. ASSESSMENT OF THE QUALITY OF ANTENATAL CARE SERVICES DELIVERED
TO PREGNANT WOMEN IN HEALTH FACILITIES IN KISARAWE DISTRICT
Getrude Haule
Masters of Health Systems Management (MHSM) (2012)
The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided. Quality of antenatal care services may be a key determinant of maternal and prenatal outcomes. The aim of this study was to assess the quality of antenatal care services provided to pregnant women in health facilities in Kisarawe District. A cross sectional descriptive study was used, 120 pregnant women were interviewed using a structured questionnaire, 16 health care providers were observed while providing service to pregnant women, a checklist was used to assess availability of facilities for providing antenatal care services. Health workers were adhering to the current recommended ANC approach known as FANC. More ever, healthcare providers provided key information to pregnant women. Investigations that are recommended to be done during antenatal care visits were performed in five out of eight health facilities involved in the study, 43.3% of pregnant women had urine test done and 54.2% had their hemoglobin level checked. Antenatal drugs and vaccine were given to almost all pregnant women who participated in the study, 95.8% received sulfadoxin-pyrimethamine tables, 85% mabendazole tables, 89.2% folic acid/ferrous sulphate tables, and 100% were vaccinated. There was proper infrastructure for the provision of antenatal care services in most health facilities involved in the study. Basic equipments for provision of antenatal care services such as adult scale, fetal stethoscope, sphynomanometer and adult stethoscope were available in all health facilities. Pregnant women involved in the study were satisfied with the health care providers because of good interpersonal relationship and the information they provided. Most women 115 (94.8%) were satisfied with the service they received as 62 (59.8%) of pregnant women rated the antenatal care services they received that they were very good. Although quality of antenatal care services provided in Kisarawe District is good, efforts should be made to improve supply system so as to ensure adequate supply of laboratory investigations reagents and equipments needed in offering ANC services in all health facilities. IS USER FEE A MOTIVATING OR DEMOTIVATING FACTOR FOR THE
COMMUNITY TO SEEK HEALTH CARE SERVICES?
A Case Study of Kolandoto Hospital
Isaliga Malimi Salehe
Masters of Health Systems Management (MHSM) (2012)
User fees were re-introduced in public health facilities in Tanzania in 1992 in order to inject funds into the health system to enhance the quality of health services. This has been an effort to increase funding on health services. In this study, drawing on in-depth interviews conducted with health staff, and community members on the area surrounding Kolandoto hospital to determine whether user fee is a motivating or demotivating factor for the community to seek health care services at Kolandoto hospital the study used ability and willingness to pay as key factors to illustrate community affordability to pay for health care costs. Other factors applied were the frequent review of health care costs together with the yardstick used in the review and patients’ attendance at the hospital. The study involved 180 respondents who were picked using random and purposive sampling techniques. The study was conducted at the Kolandoto hospital methods of data collection employed in the study were unstructured interview, questionnaire administration, documentary review from official sources and observation. Data analysis was done through EPI info and qualitatively coding and pattern building and hence conclusion. The results of the study showed that, there was a deficit of actual income when compared with actual expenditure of about 27% of which the hospital management has been forced to increase user fee of about 39% within five years to curb the situation. In addition, the study has shown that the communities are still able and willing to pay. Ability and willingness to pay was reported by 76% and 66% consecutively by the community while 80% of management members said community were able and willing to pay. However, the increase of user fees has gone hand in hand with decrease in patients’ attendance. Majority of the people contacted were able and willing to pay. However user fee has implication on patients rate visit to the health sector. This is substituted by the fact that, before re-introduced user fees, the hospital occupancy rate was 80% (2005) but in 2011 the hospital occupancy rate went down to 60%. This can easily be explained using the 24% and 34% of respondents who argued that they were neither able nor willing to contribute for the health services. Impliedly, they stood to say that Government is responsible for their health. Thus, basing ion this reality, current user fees is a motivating factor for community to seek health care services at Kolandoto hospital. CONTRIBUTION OF 5S-CQI-TQM APPROACH IN IMPROVING CLIENT
SATISFACTION IN HEALTHCARE DELIVERY
A Case Study of Mbeya Referral Hospital
Issa I. Mmbaga
Masters of Health Systems Management (MHSM) (2012)
The aim of this study was to assess client satisfaction resulting from the implementation of 5s-CQI-TQM in hospitals with Mbeya Referral Hospital as a case study. Specifically this study intended to examine availability of drugs and supplies in the hospital to determine health care providers knowledge on customer care after 5s training, identifying client expectations towards service provision and lastly to examine client waiting time. This study included, hospital staff at all levels, clients (inpatients and outpatients) and visitors. A case study design was used and data were collected mainly through interview and questionnaires. Processing and analysis of the data was done through the use of Microsoft Excel. The study included a total of 254 respondents, whereby 142 were clients, 109 hospital staff and 3 visitors from Mbeya Regional Hospital. This study proved that implementation of 5s-CQI-TQM approach contributes towards improving client satisfaction if it is well implemented. Also the study revealed that clients expect availability of drugs and supplies when they visit the hospital but 5s-COI_TQM implementation cannot guarantee availability of drugs and supplies because the approach was not designed to solve the problem of shortage of drugs and supplies, so clients reported to be dissatisfied with unavailability or shortage of drugs and supplies. Lastly this study revealed weak implementation of this approach at the hospital level that in turn leads to clients’ dissatisfaction. Researcher is of the opinion that this report will generate interest in further study of the issues relating to clients satisfaction particularly through Quality Improvement Programs in health. The report provides useful insights and details that can assist policy makers at all levels in making informed decisions. To ensure effective sustainability of this 5s-CQI-TQM, researcher recommended collaborative approach with other agreed QI program for health as approved to be used by the Ministry of Health and Social Welfare. ASSESSMENT OF UTILIZATION OF MALE CIRCUMCISION SERVICES AS A
STRATEGY TO REDUCE HIV AND AIDS SPREAD IN KAHAMA DISTRICT
Steven Tilubuza
Masters of Health Systems Management (MHSM) (2012)
Studies have shown that male circumcision reduces the risks of transmission of HIV infection. However, in areas where programs have been initiated to increase male circumcision, there is low utilization of post operative follow up care, this jeopardize the success of male circumcision as a strategy to reduce risks for HIV acquisition. The overall objective of this study was to assess utilization of post operative follow up care among circumcised males in Kahama District. A case study design was used to determine level of utilization if and identify factors for utilization of post operative follow up care among circumcised males in Kahama District. The study was conducted in four health facilities that provide male circumcision services in Kahama District. The study population consisted of 6980 individuals of whom 6967 were circumcised males and 13 male circumcision service providers. Primary data were collected from household for circumcised males and offices for service providers using questionnaire and interview guides. Observation and review of literature was done as well. A total of 95 respondents participated in the study. Findings show that utilization was 61% within 48 hours after circumcision, 31.7% seven days after circumcision and 19.5% six weeks after circumcision. Findings show positive influence of educational level, quality of services, and motive for circumcision on utilization of post operative follow up care. Also findings show that costs incurred to access service, outreach activities and knowledge to link male circumcision with reduced risks for HIV acquisition have no influence on utilization of post operative follow up care among circumcised males in Kahama District. The study recommends strengthening of male circumcised males circumcision counseling service to ensure that all prospective male circumcision clients understands well the role of male circumcision in reducing HIV and AIDS spread. FACTORS INFLUENCING LOW COVERAGE OF LATRINES IN TANZANIA
Lessons from Rorya District
Baraka Peter Mwalugelo
Masters of Health Systems Management (MHSM) (2012)
Diarrheal diseases, intestinal worms and outbreak of cholera were among top ten diseases both for under and above five years. Low latrine coverage played an important role in transmission of the above diseases, and therefore regulating this condition or improving latrine coverage can help to reduce diseases burden. Improvement in sensitization awareness campaigns which incorporated religious and cultural leaders, enforcement of environmental and sanitation by laws, women empowerment in decision making can be implemented in order to increase the latrine coverage in Rorya District. The study aimed to determine the factors influencing low coverage of latrine in Tanzania with a lesson from Rorya district. The sample size was383 though only 381respondents responded (99.5%). Out of 381 respondents, 377 were head of the households and four were Health Officers. A case study design was used and data were collected mainly through interviews, observations and questionnaires. Processing and analysis of the data was done through the use of Microsoft Excel. Results indicated that most respondents agreed with Weak bargaining power of women (60%), inadequate enforcement of Rorya district environmental and sanitation by law by district administrators (57%), shortage of health officers (100%), geological and environmental factors (57%), and low economic status of the population were the challenges towards low latrine coverage. Illiterate was not responsible for low coverage of latrine because majority of the respondents knew only one benefits of latrine (98.2%); however most of the respondents knew only one benefits (52.7%) of latrine. On the other hand majority of the respondents did not agree that religion (100%), unavailability of space for constructing latrine (85.7%) and cultural beliefs (92.4%) being the reasons for low coverage of latrine in Rorya district. The findings indicated that an educational program highlighting benefits resulted by latrine use would be an important step in increasing latrine coverage in Rorya district. CHALLENGES FACING TURIAN HOSPITAL IN THE PROCESS OF IMPLEMENTING
PUBLIC PRIVATE PARTNERSHIP IN DELIVERING HEALTH SERVICES
Pulkeria Anthony Mtavangu
Masters of Health Systems Management (MHSM) (2012)
The objective of the study was to study the challenges facing the management of Turian hospital in the process of implementing PPP in delivering health services. The study was guided by four specific objectives that sought to identify the nature of health services provided by PPP; to examine the nature of the agreement and the effectiveness of PPP; to determine factors impairing the implementation of PPP, and lastly to find out whether the contribution of PPP to the improvement of health services. There are several methods of data collection however the study data were collected through a questionnaire being the main research tool in collecting data. Interviews were also used to fill gape withy in-depth information which respondents would not be able to fill in the questionnaires. Documentary reviews, documentaries were served as a source to obtain secondary data relevant to the research topic. The data collected were analyzed using both qualitative and quantitative methods. Qualitative data were analyzed by descriptive ways such as the use of statements and tables to summarize information. The Quantitative data were coded and assigned into descriptive statistics which later on were tabulated and responses calculated as parentage, frequencies, average, and minimum and present results by the above specific objectives. The result shows that, PPP faces many challenges, for example 84% of respondents are in the view that, staff shortage, shortage of medical equipments, and drugs as well as inadequate transport facilities such as ambulance. Other challenges included delayed or lack of disbursement of funds from the government to the partner. There is not transparence between two parties that is, the government and the hospital, inadequate communication between parties. The studies recommends to government fulfils its financial and supportive responsibilities as required by PPP. CAUSES AND EFFECTS OF THE INCREASED MOTORCYCLE ACCIDENTS TO
HEALTH CARE IN MOROGORO MUNICIPALITY
Rodgers J. Baijuki
Masters of Health Systems Management (MHSM) (2012)
Motorcycle injuries constitute a major but neglected emerging health problem in Tanzania type of countries and are common cause of road traffic injuries. This study investigated the causes, effects of motorcycle accidents. Also the study aimed at assessing the effectiveness of strategies to control motorcycle accidents. The study was conducted in Morogoro Municipality within 5 wards, which were Tungi, Sabasaba, Kihonda, Kichangani and Kingurwila. Health facilities including Kigurunyembe dispensary, Kilakala maternity dispensary, Agakhan dispensary, Sabasaba health centre, Mzinga hospital, Mazimbu hospital and MRRH were involved in the study. Case study was a study design used in this research, where the selection of study respondents was done through random and non-random sampling procedures. Data were collected through documentary review, interview, questionnaires and observation methods, hence were analyzed quantitevely to get the description percentages and presented in tables and graphs. The study revealed that, motorcycle accident is a serious problem in MMC, because about 13 people lost their life in each month. The findings have shown that, there was a combination of factors increased motorcycle accident as reported by the respondents including over speed, poor parking, overloading and inexperience in driving as a result number of injuries have increased. Moreover, cost of health care to motorcycle injured victims has increased as a result affects the implementation of other health programs. For example MRRH spent Tsh. 84,920,344/= for injuries which was 19% of the annual budget for the year 2011. The issue of age and sex has been realized as the determinant factor for accidents where males between 18 – 27 years observed to be the main contributor of accidents. Due to seriousness of this public health concerns, measures including provision of road safety education reduction of licensing cost, improvement of infrastructures and amendment of Road Traffic Act (No. 30) 1973 need to be re emphasized among the motorcyclist users. ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF HEALTH
SERVICE PROVIDERS ON THE USE OF HEALTH MANAGEMENT
A Case of Singida Rural District
Charles W. Magurusa
Masters of Health Systems Management (MHSM) (2012)
This study was undertaken to assess the knowledge, attitude and practice of health service providers as most of health information generated by them is not used in decision making for the benefit of that facility, staff and the community. Specific objectives were: to assess the level of knowledge of the health service providers on utilization of health Management Information (HMI) at facility level, to find out factors hindering information utilization of HMI at health facility, to determine the practices of data collection, analysis, interpretation by the health service providers on utilization of HMI at facility level, to identify problems health service providers face in the utilization of HMI and to suggest possible action to improve knowledge, Attitude and Practice on utilization of HMI in Singida rural district. A case study was conducted in 18 health facilities in Singida rural district. Self-administered structured questionnaires were used to interview 96 health service providers on their knowledge, attitude and practice on the use of HMI in decision making and HMIS booklets from these health facilities were reviewed for data completeness. Statistical Package for Social Sciences version 14.0 was used for data analysis. The results show that 93.8% respondents filled data forms and submit health related reports required for decision making, 97.91% were involved in decision making on issues pertaining to their health facilities but only 17.7% used data. There is strong relationship between knowledge and training on HMIS. Knowledge on the use of HMI is 49%, attitude on the use of HMIS is positive 40%-70% and practice on the use of HMIS is low by 92% at health facilities. The study concluded that health service providers lack knowledge on the use of HMI in decision making. Practice of health service providers on the use of HMI is low due to lack of training and staff overworked. Although attitude on the HMIS is positive, motivation in maintaining the system is needed. Training on HMIS and appropriate information feedback to data collectors is needed hence will create appreciation and sense of ownership. HIV/AIDS KNOWLEDGE, ATTITUDE AND PRACTICES AMONG COMMUNITY
SECONDARY SCHOOL YOUTH
A Case Study of Kahama District
John Nkoba Duttu
Masters of Health Systems Management (MHSM) (2012)
The study was on HIV/AIDS knowledge, attitude and practices among community secondary school youth in Kahama District. Specific objectives of this study were to: examine the reasons behind persistent risk practices among community secondary schools students in Kahama District towards HIV/AIDS, to find out knowledge, attitude and practice of community secondary schools students towards HIV and AIDS and factors contribution to its spread in Kahama District, to find out the sources of information and knowledge about HIV and AIDS to the community secondary school students. One hundred and fifty student respondents were interviewed, 79 were males while 71 were females, all from community secondary schools. It was found that HIV/AIDS infection risk behavior was through social economic, social environment factors and knowledge, attitude and practices. It was also found that 69(46%) of respondents had unsafe sex while 75(50%) were not sexually active and 6(4%) didn’t say anything. Social economic situation to community secondary school was poor because 51(34%) said pocket money was sufficient. With regards to social Environment to community secondary school students, it was found that they rent rooms near to their schools and runs life freely without a guardian study shows that 70(46%) hire rooms, lives with family 77(51.3%) and living with different people were 3(2%). Knowledge on HIV/AIDS to community to secondary school students generally was low on transmission, sign and symptoms and prevention of the disease. It was found that prevention of HIV, abstain sex were 18(12%), one faithful HIV free partner 36(24%), and condom use 90(60%) also 6(4%) didn’t say anything. Attitude shows student have partners 84(56%) single partner and 66(44%) have multiple partners. Practice to sex in the student shows 107(71.3%) said yes and 43(28.7%) said no. the study recommends parents to provide students enough money for school use, parents and Government build school dormitories in all schools, to teach HIV/AIDS as a subject to prevent its spread. The assessment of the current strategic initiatives and efforts of chsb in enrolling
community members into community health fund schemes
The Case of Igunga District
Kapaya, Godfrey Mgongo
Masters of Health Systems Management (MHSM) (2012)
This study examined efforts done by CHSB in regards to CHF members’ enrollment in 1996-1999, review currently the different kind of CHSB activities that influence people to join CHF sche, their ability to pay premium, knowledge and attitude regarding CHF and identifying better ways for CHSB to enroll community members. This was a cross-sectional descriptive study. Focus group discussion; questionnaire and documentary review were used to collect data from 166 respondents in seven villages of two divisions in Igunga district. Statistical package for Social Sciences were used to analyze data. Study findings revealed that, 65(44%) of respondents said CHF was a top down scheme. 62(41%) respondents said that CHF enrollment was poor. CHMT, Health facility committees and CHSB not accountable with the scheme and 78(51%) said CHSB are poor in management. Study concludes that CHSB activities not effective and reliable as they have proved failure. Also, people of Igunga are willing and able to pay the premium for health services as contributions. Therefore, it is recommended that efforts should be done to improve quality of health services by increasing enrolment of CHF members. Sensitization efforts that were used during pilot period in 1996-1998 to enroll households should be applied. Moreover, every organized meeting in the district should address CHF benefits and last but not least CHSB should revisal health services packages and work with other health stakeholders to improve health services. Furthermore, the CHF coordinator should use available resources and improve CHF data base. Factors influencing non adherence to antiretroviral treatment in the urban
settings
A Case Ilala Municipal
Patric Knayamwenga
Masters of Health Systems Management (MHSM) (2012)
This study assessed the factors influencing non adherence of ARVs in Urban settings in Ilala Municipality. The objectives were; assess individual, clinical and social factors influencing non adherence to ARVs treatment in urban settings. The sample size of the study involved 393 respondents and 6 health providers from health facilities. Convenient sampling method was employed to get the sample of respondents to be involved in the study in the seven selected care and treatment centers. The study findings reveled that, almost over 50% of respondents interviewed had good awareness level on the use of ARVs drugs. This due to the fact that majority could mention the advantages of using ARVs which were mention as ARVs when used correctly and as prescribed by the Doctor could prolong life, improve health status of an individual, make someone resume his/her activities, increase immunity and other advantages. The findings further looked at factors influencing non adherence to ARVs treatment, almost 65.6% of both female and male who were interviewed did not adhere to ARVs as per the prescription and only 34.4% could be able to explain that they had adhered to the prescribed treatment. Of those who reported to be adhering to ARVs use, still females seem to have good track records adhering to treatment as compared to male by 53.3% and 46.6% respectively. For those not adhering to ARVs prescription when asked the reason for not adhering to ARVs drugs, they mentioned the following; clinical factors; unfriendly and supportive services received from the health facility, poor counseling from the providers, unfriendly language used by providers, long waiting time at the facility while waiting for the services and stigma and discrimination existing at the health facility, individual factors; stigma and discrimination at the community level. The study recommends the following to be taken on board in order to improve the adherence level among ARVs users; more trained staffs are needed to cope with increasing workloads in ART clinics hence reducing waiting times, increase access to ART clinics, as well as improving facility infrastructure, provide training staff in adherence and continuously update their knowledge about HIV and AIDS, provide training and support community counselors who operate from their homes, create proper referral networks of ARV users between facilities and lastly integrate CTC service into primary health development programmes. ROAD ACCIDENTS AND INJURIES VIS A VIS HOSPITAL CAPACITIES IN
MOROGORO MUNICIPALITY
John Zaburi Muyabaga
Masters of Health Systems Management (MHSM) (2012)
This study was done at Morogoro Regional Hospital, Sabasaba and Uhuru health facility from October 2011 to January 2012. The study aimed at assessing capacity of hospital preparedness in responding to traffic road accidents care with the aim of reducing death and disabilities and improving the quality of care. The study intended to describe the level of Hospital care and identify (capacity) major challenges in managing traffic injury cases with aim of improving hospital care and minimize the end results of injuries. Both primary and secondary data were collected using formal interview, documentary review, and questionnaire to health providers, patients and traffic polices. In order to make assessment in capacity of Hospital Care, the following questions were put forward. What is capacity of hospital emergency preparedness in responding to road traffic injury care? What is the capacity of the hospital in terms of medical equipments and suppliers? What is the capacity of Hospital communication systems with its stakeholder concerned community and policy. The study revealed that capacity of Hospital emergency preparedness towards provision on Hospital care to traffic injured patients was general poor. There was high shortage of staff especially skilled ones. Example orthopedic surgeon who is a key personnel in managing traffic injuries. However, essential medical equipment and suppliers were out of date and insufficient compared to the number of cased received. Furthermore, appropriate skills in managing traffic cases were not promising due to lack of regular training and retraining programmes to health providers. Among other serious problem MRRH being in a prone area of various disaster include road accidents has go no causality department which key important in attending traffic inures cases in time before further management to save life by giving proper first paid. Currently the Hospital has got no communication tools and unit for effective communication internally and externally communication, which make difficult to organize manpower of the Hospital, hence poor performance. It is concluded that the overall capacity of Hospital preparedness was poor. Therefore, it is recommended to enable health providers to manage traffic injury cases with full capacity in order to reduce deaths and disability. KNOWLEDGE ATTITUDE AND PRACTICES TOWARDS SYPHILIS IN PREGNANCY
Experinece from Ruangwa District
Hamidu S. Masare
Masters of Health Systems Management (MHSM) (2012)
Syphilis in pregnancy is one of the major health problems of public health importance in the world. Its importance in based on the fact that if syphilis in pregnancy will not be detected early and treated effectively will continue to be a major cause of pregnancy loss and adverse pregnancy outcome among pregnant women. Ruangwa District has high prevalence of 7.1% of syphilis among pregnant women attending Antenatal Clinic despite efforts and many campaigns and programmes conducted for more than two decades on control of sexually transmitted diseases and HIV/AIDS. A descriptive cross-sectional qualitative study on knowledge, attitudes and practices was conducted comprising of a proportionate stratified selected sample of 160 pregnant women attending antenatal care clinics, 32 focus group discussion and 9 simple randomly selected health facilities were included in this study. Information was collected to find out focused on knowledge, attitudes and practices towards syphilis in pregnancy among pregnant women attending at antenatal care clinics. Finding of the study revealed that 69.4% of respondents had low knowledge on medical importance of screening and treatment uptake of syphilis infection during pregnancy; 50% had low knowledge on signs and symptoms of syphilis; 59.4% of pregnant women had low knowledge on mode of transmission; 63.1% of pregnant women had low knowledge on ways of prevention while; 62% of pregnant women had low knowledge on consequences of untreated syphilis in pregnancy and 64% of pregnant women had low knowledge on consequences or its impact in newborn and surviving infants. This study indicates that knowledge is an inhibiting factor among pregnant women towards syphilis in pregnancy. However, negative attitudes that syphilis is a disease of prostitutes, stigma associated with STIs; cohabited, polygamy type of marriages, unsafe sex with multiple sec partners are among the factors, behavior and practices which contributes in transmission of syphilis among pregnant women knowledge of risk practices can also help to make decisions about syphilis interventions to be put in place. Intensive health education and health promotion on knowledge on risk practices and behaviors should address the problem.

Source: http://drps.mzumbe.ac.tz/documents/MHSM%20-%202012.pdf