Abstract
BackgroundHealth system performance is one of the important components of the health care delivery; its achievement depends on the quality of services rendered and the health system responsiveness of its beneficiaries. Health system responsiveness is a multi-dimensional concept and is usually measured through several domains. Health system responsiveness (HSR) remains to be a key indicator for evaluation of health system performance in any settings. This study aimed at assessing the situation of health system responsiveness in primary health facilities in Tanzania prior to introduction of the Direct Health Facility Financing (DHFF) program.MethodsThis was a cross sectional study conducted between January and February in 2018. We collected data from 42 primary health facilities (14 health centers and 28 dispensaries) where a questionnaire was administered to a total of 422 participants. The questionnaire collected information on attention, respect to dignity, clear communication, autonomy, access to care, respect to confidentiality and basic amenities. Descriptive analysis was done to determine the distribution of the variables whereas ANOVA and linear regression analysis was employed to discern the association between variables.ResultsMore than 67% of participants had visited the same health facility more than 5 times. Sixty seven percent of the patients were residing within 5kms from the public primary health care facilities. The geographical access to health care scored the lowest (43.5% for Dispensaries and 36% for Health center) mean as compared to other domains of health system responsiveness. The highest score was in respect to confidentiality (86.7%) followed by respect to dignity (81.4%). Linear regression analysis revealed no statistical association between any of the social demographic features with the overall HSR performances. However, in post hoc analysis, Pwani and Shinyanga regions didn’t differ significantly in terms of their performances whereas those two regions differ from all other regions.ConclusionBased on the study findings health system responsiveness domains has performed relatively poor in many regions except for respect of dignity and confidentiality scored high of all the domains. Shinyanga and Pwani regions scored relatively well in all domains this could have been due to the effect of Results Based financing (RBF) in the respective regions. All in all the Government and other stakeholders in the health sector they should deliberately invest on the access to care domain as seem to be a challenge as compared to others.
Highlights
Health system performance is one of the important components of the health care delivery; its achievement depends on the quality of services rendered and the health system responsiveness of its beneficiaries
More than 67% of patients were the ones who have had more than 5 times visits to the health care facility
Majority (68.9%) of Health Centers has less than 39 skilled staff while some of them they have up to 129 and majority (92.8%) of Dispensaries have less than 15 staff and some of them have 1 staff (Table 1)
Summary
Health system performance is one of the important components of the health care delivery; its achievement depends on the quality of services rendered and the health system responsiveness of its beneficiaries. Health system responsiveness (HSR) remains to be a key indicator for evaluation of health system performance in any settings. Understanding Health System Responsiveness (HSR) is vital in the development of people centered health care systems, so in the primary healthcare settings where majority (95%) of the patients access health services [1, 3]. Health system responsiveness entails the measures of the non-health aspect of care relating to the environment and the way healthcare services are provided to patients to meet their legitimate expectations. Most of the previous HSR assessments were done with a disease specific focus, such as heart failure, and among people enrolled into health insurance schemes [5, 7,8,9]
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