Browsing by Author "Hokororo, Joseph C."

Now showing 1 - 2 of 2
  • Thumbnail Image
    PublicationOpen Access
    Public Primary Health Facilities Autonomy: Findings from Tanzania Star Rating Assessment
    (Int J Health Policy Plann, 2023-06-21) Mwaisengela, Syabo M.; Ngowi, Ruth R.; Msigwa, Yohannes S.; Degeh, Mbwana M.; Marandu, Laura E.; German, Chrisogone J.; Hokororo, Joseph C.; Kinyenje, Erick S.; Bahegwa, Radenta P.; Yahya, Talhiya A.
    Background: In many countries, health facility autonomy has been a crucial component of health sector reform. Reducing direct government control over public health facilities and increasing their exposure to the market and market-like forces are part of this reform strategy. The degree of financial independence is a crucial characteristic that determines health facility financing and it has an impact on how well public health facilities function. This study aims at ascertaining Primary Health Facilities autonomy in the context of Star Rating Assessment (SRA) in Tanzania. Methods: This is a quantitative secondary data analysis using the SRA re-assessment data collected in the fiscal year 2017/18. Facility autonomy was measured by the desirable performance of six indicators, namely submission of a health facility plan, Int J Health Policy Plann, 2023 Volume 2 | Issue 2 | 83 Keywords: Primary Health Care, Star Rating Assessment, Autonomy having operational bank account, competent handling of funds and financial reporting, deposit of self-generated funds in a facility bank account, health facility receiving any part of budgeted funds for Other Charges (OC) or Health Sector Basket Funds (HSBF) and appropriate expenditure on health commodities as stipulated in Health Facility Plans guidelines. The proportions were compared by using one and two sample proportion Z and chi-square tests. We employed Poisson regression to ascertain factors influencing facility autonomy among public primary health facilities. Results: This study involved 3,666 PHC facilities, the majority of which were dispensaries (97.6%) and rural located (85.9%). On average, 23.3% of health facilities were autonomous. 60.8% of urban located health facilities (95% CI=56.6%- 65.0%) are autonomous which is higher than 56.7% of health facilities that are located in rural areas (95% CI=55.0%- 58.5%), this difference is statistically significant (p=0.008). On the other hand, 84.6% of district hospitals were autonomous (95% CI=73.3%-96.0%) which is significantly higher compared to 57.0% of autonomous lower-level health facilities (health centers and dispensaries) (95% CI=55.4%-58.7%, p<0.001). Conclusions: In Tanzanian PHC facilities, public primary health facility autonomy is a challenge. The challenge is more prevalent in rural located health facilities and lower-level PHC facilities (dispensaries and Health centers). Enhancing the effectiveness of Quality Improvement Teams (QITs) and Health Management Teams (HMTs) should be one of the measures considered in order to increase the autonomy of PHC facilities.
  • Thumbnail Image
    PublicationOpen Access
    Status of countrywide laboratory services quality and capacity in primary healthcare facilities in Tanzania: Findings from Star Rating Assessment
    (Plos Global Public Health, 2023-10-18) Kinyenje, Erick; Ngowi, Ruth R.; Msigwa, Yohanes S.; Hokororo, Joseph C.; Yahya, Talhiya A.; German, Chrisogone J.; Mawazo, Akili; Mohamed, Mohamed A.; Nassoro, Omary A.; Degeh, Mbwana M.
    Accurate disease diagnosis relies on a well-organized and reliable laboratory system. This study assesses the quality of laboratory services in Tanzania based on the nationwide Star Rating Assessment (SRA) of Primary Healthcare (PHC) facilities conducted in 2017/18. This cross-sectional study utilized secondary data from all the country’s PHC facilities stored in the SRA database. Laboratory service quality was assessed by aggregating scores as percentages of the maximum achievable score across various indicators: dedicated laboratory department/room, adequate equipment, staffing levels, adherence to testing protocols, establishment of turnaround times, internal and external quality controls, and safety and supplies management. Scores equal to or exceeding 80% were deemed compliant. Multiple linear regression was used to determine the influence of facility characteristics (level, ownership, location, staffing) on quality scores, with statistical significance set at p < 0.05. The study included 6,663 PHC facilities (85.9% dispensaries, 11% health centers, 3.2% hospital-level-1), with the majority being public (82.3% vs. 17.7%) and located in rural areas (77.1% vs. 22.9%). On average, facilities scored 30.8% (SD = 35.7), and only 26.6% met staffing requirements. Compliance with quality standards was higher in private (63% vs. 19%, p<0.001) and urban facilities (62% vs. 16%, p<0.001). More than half of the facilities did not meet either of the eight quality indicators. Quality was positively linked to staffing compliance (Beta = 5.770) but negatively impacted by dispensaries (Beta = -6.342), rural locations (Beta = -0.945), and public ownership (Beta = -1.459). A score of 30% falls significantly short of the national target of 80%. Improving laboratory staffing levels at PHC facilities could improve the quality of laboratory services, especially in public facilities that are based in rural areas. There is a need to further strengthen laboratory services in PHC facilities to ensure the quality of laboratory services and clients’ satisfaction.