Tanzania Service Provision Assessment Survey Research Articles

Readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania: A nationwide analysis for evidence-informed policy-making in high burden settings.

Double disease burden such as Tuberculosis and Diabetes mellitus comorbidity is evident and on rising especially in high burden settings such as Tanzania. There is limited information about the availability of tuberculosis/diabetes integrated healthcare services in Tanzania. Therefore, this study explored the availability and examined the readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania. We abstracted data from the 2014-2015 Tanzania Service Provision Assessment Survey datasets. The service availability was assessed by calculating the proportion of tuberculosis facilities reported to manage diabetes mellitus. There were four domains; each domain with some indicators for calculating the readiness index. High readiness was considered if the tuberculosis facilities scored at least half (≥50%) of the indicators listed in each of the four domains (staff training and guideline, diagnostics, equipment, and medicines) as is recommended by the World Health Organization-Service Availability and Readiness Assessment manual while low readiness for otherwise. Out of 341 healthcare facilities with tuberculosis services included in the current study, 238 (70.0%) reported providing management for diabetes mellitus. The majority of the facilities were dispensaries and clinics 48.1%; publicly owned 72.6%; and located in rural 62.6%. Overall, the readiness of tuberculosis facilities to manage diabetes was low (10.8%). Similarly, the readiness was low based on the domain-specific readiness of trained staff and guidelines. Although the majority of the healthcare facilities with tuberculosis services had diabetes mellitus services the overall readiness was low. This finding provides a piece of evidence to inform the policymakers in high burden and low resource countries to strengthen the co-management of tuberculosis and diabetes.

Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania

BackgroundProvider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania.MethodsThis study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant.ResultsOut of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]).ConclusionIn order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania.

Disparities in availability of services and prediction of the readiness of primary healthcare to manage diabetes in Tanzania

BackgroundThe burdens of Non-communicable Diseases have overstretched health systems in developing countries. The study explores disparities in the availability of services and predicts the readiness of primary healthcare facilities to manage diabetes in Tanzania. MethodsThe study analyzed data from the 2014–2015 Tanzania Service Provision Assessment Survey. A total of 1142 primary healthcare facilities were included in this analysis. The Negative binomial regression models were fitted to predict each of selected independent variable that is associated with the readiness of primary healthcare to manage diabetes. ResultsThe overall availability of services was significantly different across the type of facility and managing authority. In an adjusted model, the following were the predictors for a significant increase in readiness to manage diabetes: health center [β = 0.470], private facilities [β = 0.252], the performance of management meetings [β = 0.446], having source of fund other than government [β = 0.193,], and presence of medical doctors [β = 0.677]. ConclusionThe robust primary care systems to manage diabetes could be achieved by improving the readiness of primary healthcare facilities through optimizing the availability of diagnostic tools, basic medicines, medical doctors, and early release of a government fund to publicly-owned facilities.

Preparedness of health facilities providing HIV services during COVID-19 pandemic and assessment of their compliance to COVID-19 prevention measures: findings from the Tanzania Service Provision Assessment (SPA) survey.

the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.

Availability and readiness of diabetes health facilities to manage tuberculosis in Tanzania: a path towards integrating tuberculosis-diabetes services in a high burden setting?

BackgroundThe burden of tuberculosis (TB) and diabetes mellitus (DM) is rising and substantially affecting the low-income countries, including Tanzania. Integrated management of TB and DM is becoming of importance in TB high burden countries. In this study, we sought to assess the availability and readiness of diabetes facilities to manage TB in Tanzania.MethodsThe present study was based on a secondary analysis of the 2014–2015 Tanzania Service Provision Assessment Survey data. We calculated the service availability as a percentage of diabetes facilities offering TB services: diagnosis and treatment. Regarding the readiness of diabetes facilities to provide TB management, we calculated based on the three domains: staff training and guideline, diagnostics, and medicines as identified by World Health Organization-Service Availability and Readiness Assessment (SARA) manual. A score of at least half (≥50%) of the indicators listed in each of the three domains was considered as high readiness. We used a descriptive statistics to present our findings.ResultsThere were 619 DM facilities all over the country of which only 238 (38.4%) had TB services.72.6 and 62.6% of these DM facilities with TB services were publicly owned and located in rural settings respectively. Generally, DM facilities had low readiness to manage TB; 12·6%. More specifically, all DM facilities had low readiness in terms of trained staff and guidelines. However, in the domain of diagnostics and medications, higher levels of care (hospitals) had a comparatively higher level of readiness to manage TB.ConclusionMost of the DM facilities had low availability and readiness to manage TB. The findings of our study display an urgent need to mobilize important resources to enhance the integration of TB services in DM facilities. This includes medications, management guidelines, diagnostics, and health professionals who have received refresher training on TB/DM co-management. However, presently, few DM facilities may be allowed to start managing TB as per the Strategic and Action Plan for the Prevention and Control of Non-Communicable Diseases in Tanzania 2016–2020.

Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care.

IntroductionDespite the benefits of early antenatal care visits for early prevention, detection, and treatment of potential complications in pregnancy, a high level of provider adherence to first-visit antenatal care standards is needed. However, little information is available regarding provider adherence to antenatal care in Tanzania. This study was performed to assess provider adherence to first-visit antenatal care standards and to apply stratified analysis to identify associated factors in Tanzania.MethodsData from the 2014–2015 Tanzania Service Provision Assessment Survey were used in this study. Provider adherence to first-visit antenatal care standards was measured using 10 domains: client history; aspects of prior pregnancies; danger signs of the current pregnancy; physical examination; routine tests; HIV testing and counseling; maintaining a healthy pregnancy; iron/folate supplements; tetanus toxoid vaccination, and preparation for delivery. A composite score was then created in which the highest quantile (corresponding to ≥60.5%) considered to provider adhering to first-visit antenatal care standards. Initially, a series of unadjusted logistic regression analyses according to the type of facility and managing authority were performed separately at each level (i.e., facility, provider, and client). Thereafter, all variables with P < 0.2 were fitted into the respective stratified multivariable logistic regression analysis using a 5% significance level.ResultsA total of 1756 first-visit antenatal care consultations performed by 822 providers in 648 health facilities were analyzed. The overall median [Interquartile range, IQR] adherence to first-visit antenatal care was relatively low at 47.1% [35.7%–60.5%]. After adjusting for selected variables from each level in specific strata, at dispensary; female providers [AOR = 5.5; 95% CI, 1.8–16.4], at health centre; performance of quality assurance [AOR = 2.2; 95% CI, 1.3–3.9], at hospital; availability of routine tests [AOR = 2.5; 95% CI, 1.3–4.8] and basic medicine [AOR = 2.8; 95% CI, 1.4–5.7], at public facilities; availability of medicine [AOR = 1.8; 95% CI, 1.1–3.2] and receiving refresher training [AOR = 1.8; 95% CI, 1.1–3.1], and at private facility; receiving external fund from government [AOR = 3.0; 95% CI, 1.1–8.4] were significantly associated with better adherence to first-visit antenatal care standards.ConclusionsThe study highlighted the important factors, including the provision of refresher training, regular distribution of basic medicines, and diagnostics equipment which may influence provider adherence to first-visit ANC standards.

Are Tanzanian health facilities ready to provide management of chronic respiratory diseases? An analysis of national survey for policy implications.

IntroductionChronic respiratory diseases in Tanzania are prevalent and a silent burden to the affected population, and healthcare system. We aimed to explore the availability of services and level of health facilities readiness to provide management of chronic respiratory diseases and its associated factors.MethodsThe current study is a secondary analysis of the 2014–2015 Tanzania Service Provision Assessment Survey data. Facilities were considered to have a high readiness to provide management of chronic respiratory diseases if they scored at least half (≥50%) of the indicators listed in each of the three domains (staff training and guideline, equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Descriptive, unadjusted and adjusted logistic regression analyses were performed. A P value < 0.05 was taken to indicate statistical significance.ResultsOut of 723 facilities included in this analysis, approximately one-tenth had a high readiness to provide management of chronic respiratory diseases. Less than 10% of the facilities had at least one staff who received training for management of chronic respiratory diseases. In an adjusted model, privately owned facilities [AOR = 3.3; 95% CI, 1.5–7.5], hospitals [AOR = 11.6; 95% CI, 5.0–27.2], health centres [AOR = 5.0; 95% CI, 2.4–10.7], and performance of routine management meeting [AOR = 3.3; 95% CI, 1.4–7.8] were significantly associated with high readiness to provide management for chronic respiratory diseases.ConclusionMajority of Tanzanian health facilities have low readiness to provide management for chronic respiratory diseases. There is a need for the Tanzanian government to increase the availability of diagnostic equipment, medication, and to provide refresher training specifically in the lower-level and public health facilities for better management of chronic respiratory diseases and other non-communicable diseases.

Client satisfaction with family planning services in the area of high unmet need: evidence from Tanzania Service Provision Assessment Survey, 2014-2015

BackgroundClient satisfaction has been found to be an important factor for the uptake and continuation of family planning services. This study aimed to examine the current status of and factors associated with client’s satisfaction with family planning services in Tanzania, which has a high unmet need for family planning.MethodsThe study used data from the Tanzania Service Provision Assessment survey of 2014–2015. A facility was classified as having high service readiness for FP if it scored at least 67.7% on a composite score based on three domains (staff training and guidelines, basic diagnostic equipment, and basic medicines), following criteria developed by the World Health Organization. The exit interview questionnaire was used to collect information from women about their level of satisfaction, whether “very satisfied,” “more or less satisfied,” or not satisfied with the services received. The response was dichotomized into “Yes” if the woman reported being very satisfied with services received otherwise coded as “No”. Unadjusted and adjusted logistic regression models were used to assess the association between the client satisfaction and covariate variables; service readiness, facility type, managing authority, location, management meetings, supervision, provider’s sex, and working experience, clients’ age and education. All analyses were weighted to correct for non-response, disproportionate and complex sampling by using the “SVY” command in Stata 14.ResultsOut of the 1188 facilities included in the survey, 427 (35.9%) provided family planning services. A total of 1746 women participated in observations and exit interviews. Few (22%) facilities had a high readiness to provide family planning services. While most facilities had the recommended equipment available, only 42% stocked contraceptives (e.g. oral pills, injectable contraceptives and/or condoms). Further, trained staff and clinical guidelines were present in only 30% of services. Nevertheless, the majority (91%) of clients reported that they were satisfied with services. In the multivariate analysis, a high service readiness score [AOR = 2.5, 95% CI; 1.1–6.0], receiving services from private facilities [AOR = 2.3, 95% CI; 1.1–5.0], and being in the age group 20 to 29 years [AOR = 0.3, 95% CI; 0.1–0.7] were all significantly associated with clients’ satisfaction with family planning services.ConclusionThere is a high level of client satisfaction with family planning services in Tanzania. Maintaining and exceeding this level will require improvements in the provision of staff training and the availability of contraceptives in existing services.

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

IntroductionSub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania.MethodsThis study used data from the 2014–2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level.ResultsOut of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2–6.1], urban location [AOR = 2.2, 95% CI; 1.2–4.2], health centers [AOR = 5.2, 95% CI; 3.1–8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1–5.9] were significantly associated with preparedness for the outpatient primary care of hypertension.ConclusionThe primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes.

Determinants of facility readiness for integration of family planning with HIV testing and counseling services: evidence from the Tanzania service provision assessment survey, 2014\u20132015

BackgroundGlobal policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. However, the status of integration between these two services in Tanzanian health facilities is unclear. This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania.MethodsData from the 2014–2015 Tanzania Service Provision Assessment Survey were analyzed. Facilities were considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. All analyses were adjusted for clustering effects, and estimates were weighted to correct for non-responses and disproportionate sampling. Descriptive, bivariate, and multivariate logistic regression analyses were performed.ResultsA total of 1188 health facilities were included in the study. Of all of the health facilities, 915 (77%) reported offering both family planning and HIV testing and counseling services, while only 536 (45%) were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned [AOR = 3.2; 95%CI, 1.9–5.6], having routine management meetings [AOR = 1.9; 95%CI, 1.1–3.3], availability of guidelines [AOR = 3.8; 95%CI, 2.4–5.8], in-service training of staff [AOR = 2.6; 95%CI, 1.3–5.2], and availability of laboratories for HIV testing [AOR = 17.1; 95%CI, 8.2–35.6].ConclusionThe proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania is unsatisfactory. The Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and the provision of refresher training to health providers, as these were among the determinants of facility readiness.

Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey.

BackgroundService Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa. Intended to provide useful descriptive information on health system functioning to supplement the Demographic and Health Survey data, each SPA produces a plethora of discrete indicators that are so numerous as to be impossible to analyze in conjunction with population and health survey data or to rate the relative readiness of individual health facilities. Moreover, sequential SPA surveys have yet to be analyzed in ways that provide systematic evidence that service readiness is improving or deteriorating over time.MethodsThis paper presents an illustrative analysis of the 2006 Tanzania SPA with the goal of demonstrating a practical solution to SPA data utilization challenges using a subset of variables selected to represent the six building blocks of health system strength identified by the World Health Organization (WHO) with a focus on system readiness to provide service. Principal Components Analytical (PCA) models extract indices representing common variance of readiness indicators. Possible uses of results include the application of PCA loadings to checklist data, either for the comparison of current circumstances in a locality with a national standard, for the ranking of the relative strength of operation of clinics, or for the estimation of trends in clinic service quality improvement or deterioration over time.ResultsAmong hospitals and health centers in Tanzania, indices representing two components explain 32 % of the common variance of 141 SPA indicators. For dispensaries, a single principal component explains 26 % of the common variance of 86 SPA indicators. For hospitals/HCs, the principal component is characterized by preventive measures and indicators of basic primary health care capabilities. For dispensaries, the principal component is characterized by very basic newborn care as well as preparedness for delivery.ConclusionsPCA of complex facility survey data generates composite scale coefficients that can be used to reduce indicators to indices for application in comparative analyses of clinical readiness, or for multi-level analysis of the impact of clinical capability on health outcomes or on survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1203-7) contains supplementary material, which is available to authorized users.