Dr Ntuli A. Kapologwe, MD,PhD cand - President's Office Regional Admnistration and Local Government - Director of Health, Social Welfare and Nutrition Service

Dr Ntuli A. Kapologwe

MD,PhD cand

President's Office Regional Admnistration and Local Government

Director of Health, Social Welfare and Nutrition Service

Dodoma, Dodoma | Tanzania, United Republic of

Additional Specialties: Health Systems and Implementation science

ORCID logohttps://orcid.org/0000-0003-0900-2937

Dr Ntuli A. Kapologwe, MD,PhD cand - President's Office Regional Admnistration and Local Government - Director of Health, Social Welfare and Nutrition Service

Dr Ntuli A. Kapologwe

MD,PhD cand

Introduction

Primary Affiliation: President's Office Regional Admnistration and Local Government - Dodoma, Dodoma , Tanzania, United Republic of

Additional Specialties:

Research Interests:

Education

Sep 2000 - Sep 2005
University of Dar es Salaam
MD
Health

Experience

Jan 2017
United Republic of Tanzania President's Office
Director
Health, Social Welfare and Nutrition Services

Publications

25Publications

217Reads

74Profile Views

14PubMed Central Citations

Strengthening accountability for better health outcomes through understanding health-system bottlenecks: insights from Tanzania

https://scholar.google.com/citations?user=WiEPVywAAAAJ&hl=en#d=gs_md_cita-d&u=%2Fcitations%3Fview_op%3Dview_citation%26hl%3Den%26user%3DWiEPVywAAAAJ%26citation_for_view%3DWiEPVywAAAAJ%3AKlAtU1dfN6UC%26tzom%3D-120

Anti-Corruption evidence

Corruption is a worldwide concern. Within Tanzania, the landmark Warioba report (URT, 1996) confirmed the existence of extensive corruption across all sectors of the country, including in the public health sector where corruption has been reported at almost every stage of care-seeking.
Based on an in-depth review of peer reviewed and grey literature, and complemented by key informant discussions with selected health-system stakeholders, this study seeks to deepen our understanding of informal practices amongst frontline public health providers in mainland Tanzania’s health sector, to explore the incentives that give rise to such practices, and to identify current formal and informal accountability and system-strengthening measures. Taken together, this evidence can be used to inform policy and practice in order to constrain such informal practices.

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May 2019
3 Reads

Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania

http://dx.doi.org/10.1136/bmjgh-2018-001282

BMJ Global Health

Abstract

Despite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania.

The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved broad consultation with over 200 stakeholders from across government, professional associations, clinicians, ancillary staff, civil society and patient organisations. The NSOAP describes time-bound, costed strategic objectives, outputs, activities and targets to improve each domain of the SOA system. The final NSOAP is ambitious but attainable, reflects on-the-ground priorities, aligns with existing health policy and costs an additional 3% of current healthcare expenditure.

Tanzania is the third country to complete such a plan and the first to report on the NSOAP development in such detail. The NSOAP development in Tanzania provides a roadmap for other countries wishing to undertake a similar NSOAP development to strengthen their SOA system.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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April 2019
1 Read

Effects of short-term cash and food incentives on food insecurity and nutrition among HIV-infected adults in Tanzania.

AIDS 2019 Mar;33(3):515-524

Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA.

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http://dx.doi.org/10.1097/QAD.0000000000002056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511258PMC
March 2019
18 Reads
5.554 Impact Factor

Jazia prime vendor system- a public-private partnership to improve medicine availability in Tanzania: from pilot to scale.

J Pharm Policy Pract 2019 25;12. Epub 2019 Feb 25.

Director of Health Services, Social Welfare and Nutrition Services, President's Office of Regional Administration and Local Government, Dodoma, Tanzania.

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http://dx.doi.org/10.1186/s40545-019-0163-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388475PMC
February 2019
3 Reads

Women's Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania.

Int J Environ Res Public Health 2019 02 7;16(3). Epub 2019 Feb 7.

Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.

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http://dx.doi.org/10.3390/ijerph16030481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388277PMC
February 2019
2 Reads
2.063 Impact Factor

Women’s Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania

https://doi.org/10.3390/ijerph16030481

Int. J. Environ. Res. Public Health

Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15–49 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women’s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages. View Full-Text

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February 2019
34 Reads

Jazia prime vendor system- a public-private partnership to improve medicine availability in Tanzania: from pilot to scale

DOI: 10.1007/s00268-018-4767-7

Journal of Pharmaceutical Policy and Practice

Background

The availability of medicines in public health facilities in Tanzania is problematic. Medicines shortages are often caused by unavailability at Medical Stores Department, the national supplier for public health facilities. During such stock-outs, districts may purchase from private suppliers. However, this procedure is intransparent, bureaucratic and uneconomic.

Objectives

To complement the national supply chain in case of stock-outs with a simplified, transparent and efficient procurement procedure based on a public-private partnership approach with a prime vendor at the regional level. To develop a successful pilot of a Prime Vendor system with the potential for national scale-up.

Methods

A public-private partnership was established engaging one private sector pharmaceutical supplier as the Prime Vendor to provide the complementary medicines needed by public health facilities in Tanzania. The Dodoma pilot region endorsed the concept involving the private sector, and procedures to procure complementary supplies from a single vendor in a pooled regional contract were developed. A supplier was tendered and contracted based on Good Procurement Practice. Pilot implementation was guided by Standard Operating Procedures, and closely monitored with performance indicators. A 12-step approach for national implementation was applied including cascade training from national to facility level. Each selected vendor signed a contract with the respective regional authority.

Results

In the pilot region, tracer medicines availability increased from 69% in 2014 to 94% in 2018. Prime vendor supplies are of assured quality and average prices are comparable to prices of Medical Stores Department. Procurement procedures are simplified, shortened, standardized, transparent and well-governed. Procurement capacity was enhanced at all levels of the health system. Proven successful, the Prime Vendor system pilot was rolled-out nationally, on government request, to all 26 regions of mainland Tanzania, covering 185 councils and 5381 health facilities.

Conclusion

The Prime Vendor system complements regular government supply through a regional contract approach. It is anchored in the structures of the regional health administration and in the decentralisation policy of the country. This partnership with the private sector facilitates procurement of additional supplies within a culture of transparency and accountability. Regional leadership, convincing pilot results and policy dialogue have led to national roll-out. Transferring this smaller-scale supply chain intervention to other regions requires country ownership and support for sustainable operations.

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February 2019
4 Reads

Understanding the implementation of Direct Health Facility Financing and its effect on health system performance in Tanzania: a non-controlled before and after mixed method study protocol.

Health Res Policy Syst 2019 Jan 30;17(1):11. Epub 2019 Jan 30.

Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.

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https://health-policy-systems.biomedcentral.com/articles/10.
Publisher Site
http://dx.doi.org/10.1186/s12961-018-0400-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354343PMC
January 2019
14 Reads

Bank accounts for public primary health care facilities: Reflections on implementation from three districts in Tanzania.

Int J Health Plann Manage 2019 Jan 20;34(1):e860-e874. Epub 2018 Nov 20.

Health Systems Department, Ifakara Health Institute, Dar es Salaam, Tanzania.

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http://dx.doi.org/10.1002/hpm.2702DOI Listing
January 2019
28 Reads

Understanding the implementation of Direct Health Facility Financing and its effect on health system performance in Tanzania: a non-controlled before and after mixed method study protocol

https://doi.org/10.1186/s12961-018-0400-3

Health Research Policy and Systems

Background

Globally, good health system performance has resulted from continuous reform, including adaptation of Decentralisation by Devolution policies, for example, the Direct Health Facility Financing (DHFF). Generally, the role of decentralisation in the health sector is to improve efficiency, to foster innovations and to improve quality, patient experience and accountability. However, such improvements have not been well realised in most low- and middle-income countries, with the main reason cited being the poor mechanism for disbursement of funds, which remain largely centralised. The introduction of the DHFF programme in Tanzania is expected to help improve the quality of health service delivery and increase service utilisation resulting in improved health system performance. This paper describes the protocol, which aims to evaluate the effects of DHFF on health system performance in Tanzania.

Methods

An evaluation of the effect of the DHFF programme will be carried out as part of a nationwide programme rollout. A before and after non-controlled concurrent mixed methods design study will be employed to examine the effect of the DHFF programme implementation on the structural quality of maternal health, health facility governing committee governance and accountability, and health system responsiveness as perceived by the patients’ experiences. Data will be collected from a nationally representative sample involving 42 health facilities, 422 patient consultations, 54 health workers, and 42 health facility governing committees in seven regions from the seven zones of the Tanzanian mainland. The study is grounded in a conceptual framework centered on the Theory of Change and the Implementation Fidelity Framework. The study will utilise a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews and documentary review). The study will collect information related to knowledge, acceptability and practice of the programme, fidelity of implementation, structural qualities of maternal and child health services, accountability, governance, and patient perception of health system responsiveness.

Discussion

This evaluation study will generate evidence on both the process and impact of the DHFF programme implementation, and help to inform policy improvement. The study is expected to inform policy on the implementation of DHFF within decentralised health system government machinery, with particular regard to health system strengthening through quality healthcare delivery. Health system responsiveness assessment, accountability and governance of Health Facility Government Committee should bring autonomy to lower levels and improve patient experiences. A major strength of the proposed study is the use of a mixed methods approach to obtain a more in-depth understanding of factors that may influence the implementation of the DHFF programme. This evaluation has the potential to generate robust data for evidence-based policy decisions in a low-income setting.

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January 2019
115 Reads

Bank accounts for public primary health care facilities: Reflections on implementation from three districts in Tanzania

https://doi.org/10.1002/hpm.2702

The International Journal of Health Planning and Management

Health care financing reforms are gaining popularity in a number of African countries to increase financial resources and promote financial autonomy, particularly at peripheral health care facilities. The paper explores the establishment of facility bank accounts at public primary facilities in Tanzania, with the intention of informing other countries embarking on such reform of the lessons learned from its implementation process. A case study approach was used, in which three district councils were purposively sampled. A total of 34 focus group discussions and 14 in‐depth interviews were conducted. Thematic content analysis was used during analysis. The study revealed that the main use of bank account revenue was for the purchase of drugs, medical supplies, and minor facility needs. To ensure accountability for funds, health care facilities had to submit monthly reports of expenditures incurred. District managers also undertook quality control of facility infrastructure, which had been renovated using facility resources and purchases of facility needs. Facility autonomy in the use of revenue retained in their accounts would improve the availability of drugs and service delivery. The experienced process of opening facility bank accounts, managing, and using the funds highlights the need to strengthen the capacity of staff and health‐governing committees.

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November 2018
58 Reads

Effects of short-term cash and food incentives on food insecurity and nutrition among HIV-infected adults in Tanzania: a randomized trial

DOI:10.1097/QAD.0000000000002056

AIDS

Objective: Food insecurity impedes antiretroviral therapy (ART) adherence. We previously demonstrated that short-term cash and food incentives increased ART possession and retention in HIV services in Tanzania. To elucidate potential pathways that led to these achievements, we examined whether incentives also improved food insecurity. Design: Three-arm randomized controlled trial. Methods: From 2013 to 2015, 805 food-insecure adult ART initiates (90 days) at three clinics were randomized to receive cash or food transfers ($11 per month for 6 months, conditional on visit attendance) or standard-of-care (SOC) services. We assessed changes from baseline to 6 and 12 months in: food insecurity (severe; access; dietary diversity), nutritional status (body weight; BMI), and work status. Difference-in-differences average treatment effects were estimated using inverse-probability-of-censoring-weighted longitudinal regression models. Results: The modified intention-to-treat analysis included 777 nonpregnant participants with 41.6% severe food insecurity. All three study groups experienced improvements from baseline in food insecurity, nutritional status, and work status. After 6 months, severe food insecurity declined within the cash (31.4% points to 11.5%) and food (30.3 to 10.4%) groups, but not within the SOC. Relative to the SOC, severe food insecurity decreased by an additional 24.3% points for cash (95% CI 45.0 to 3.5) and 23.3 percent points for food (95% CI 43.8 to 2.7). The interventions neither augment improvements in severe food insecurity at 12 months, nor food access, dietary diversity, nutritional status, or work status at 6 or 12 months. Conclusion: Small cash and food transfers provided at treatment initiation may mitigate severe food insecurity. These effects may have facilitated previously observed improvements in ART adherence.

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October 2018
7 Reads

The heterogeneous effect of short-term transfers for improving ART adherence among HIV-infected Tanzanian adults

https:/ AIDS Care, 30:sup3, 18-26, doi.org/10.1080/09540121.2018.1476666

AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV

ABSTRACT A recently concluded randomized study in Tanzania found that short-term conditional cash and food transfers significantly improved HIV-infected patients’ possession of antiretroviral therapy (ART) and reduced patient loss to follow-up (LTFU) (McCoy, S. I., Njau, P. F., Fahey, C., Kapologwe, N., Kadiyala, S., Jewell, N. P., & Padian, N. S. (2017). Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania. AIDS, 31(6), 815–825. doi:10.1097/QAD.0000000000001406). We examined whether these transfers had differential effects within population subgroups. In the parent study, 805 individuals were randomized to one of three study arms: standard-of-care (SOC) HIV services, food assistance, or cash transfer. We compared achievement of the medication possession ratio (MPR) ≥ 95% at 6 and 12 months and patient LTFU at 12 months between those receiving the SOC and those receiving food or cash (combined). Using a threshold value of p < 0.20 to signal potential effect measure modifiers (EMM), we compared intervention effects, expressed as risk differences (RD), within subgroups characterized by: sex, age, wealth, and time elapsed between HIV diagnosis and ART initiation. Short-term transfers improved 6 and 12-month MPR ≥ 95% and reduced 12-month LTFU in most subgroups. Study results revealed wealth and time elapsed between HIV diagnosis and ART initiation as potential EMMs, with greater effects for 6-month MPR ≥ 95% in the poorest patients (RD: 32, 95% CI: (9, 55)) compared to those wealthier (RD: 16, 95% CI: (5, 27); p = 0.18) and in newly diagnosed individuals (<90 days elapsed since diagnosis) (RD: 25, 95% CI: (13, 36)) compared to those with ≥90 days (RD: 0.3, 95% CI (−17, 18); p = 0.02), patterns which were sustained at 12 months. Results suggest that food and cash transfers may have stronger beneficial effects on ART adherence in the poorest patients. We also provide preliminary data suggesting that targeting interventions at patients more recently diagnosed with HIV may be worthwhile. Larger and longer-term assessments of transfer programs for the improvement of ART adherence and their potential heterogeneity by sub-population are warranted.

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July 2018
19 Reads

Mentoring to build midwifery and nursing capacity in the Africa region: An integrative review

https://doi.org/10.1016/j.ijans.2017.10.002

Elsevier International Journal of Africa Nursing Sciences

The World Health Organizations (WHO) recognizes that building capacity of health care providers as a foundational strategy to achieving and maintaining an optimal and stable supply and distribution of appropriately trained, supported and motivated health workforce that is responsive to locally specific health care needs (WHO Regional Office for Africa, 2006). Ensuring available, accessible, acceptable and high quality health care systems are directly impacted by the ability to train and sustain a healthy and supported workforce. Growing attention in the global health community is focused on developing comprehensive strategies to address the acute healthcare worker shortages in rural and remote areas. One strategy that has the potential to retain senior clinicians while simultaneously recruiting newer clinicians may lie in placing value in developing mentoring and positive supervisory relationships (Nancarrow, Roots, Grace, Moran, & Vanniekerk-Lyons, 2013). In 2006, the African Region was classified as having the one of the most severe health workforce shortages. Rural and remote areas were experiencing the most acute impact of HRH shortages. The WHO called upon Member States in the African Region to undertake practical measures to address the human resources for health (HRH) crisis facing these countries and to take active measures to address this critical health worker shortage (WHO Regional Office for Africa, 2013). Focusing initiatives to recruit and retain clinicians could ensure adequate numbers and quality of health workers, which ultimately ensures universal access to quality health care. Tanzania is one of the 57 countries identified by the WHO as facing a HRH crisis. Tanzania reports 3.2 nurses and nurse-midwives per 10,000 people; the optimal ratio is 16 per 10,000 in LMIC as per WHO (Macias & Mwijarubi, 2013). There is an estimated shortage of 184,100 HRH in the country (The United Republic of Tanzania Human Resource for Health., 2013a; World Health Organization., 2013). The Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), heeding this call, developed a five year strategic plan to address the grave shortage of health care workers and considered it as “a national crisis requiring continuous and collaborative attention” (The United Republic of Tanzania Human Resource for Health, 2013, p. viii). The Tanzanian MoHCDGEC reports that a fivefold increase maternal health workforce is needed to fill their shortages and address the healthcare needs of millions of women and families (United Republic of Tanzania: Ministry of Health, 2008). While opening more training facilities and training more workers is vital, it is also recognized that retaining and supporting the existing workforce is crucial. The strategic plan put forth by the Tanzanian MoHCDGEC includes: 1) ensuring constant supportive supervision; 2) performance monitoring and evaluation for skills improvement and; 3) building working environments that attract, promote, and retain health workers in all sectors of the Tanzanian health system (The United Republic of Tanzania Human Resource for Health., 2013b). Given this critical shortage of health workers in countries like Tanzania, innovative strategies aimed at building, training, and retaining a resilient workforce are warranted (Chen et al., 2004). Historically, the impact of many health professional training initiatives in low-income countries have narrowly focused on a small set of diseases with capacity building limited to skills and knowledge related to those diseases (Cancedda et al., 2015). Initiatives with broadly applicable skills were few. Furthermore, the evidence demonstrates that practicing health workers are often overwhelmed by the intense work of delivering health services in under-supplied and over-crowded hospitals and clinics, inadequately compensated for their work, and demoralized by a lack of continuing professional development opportunities (Hongoro & McPake, 2004; Willis-Shattuck et al., 2008; World Health Organization, 2006). Multiple studies also demonstrate that health care workers who receive professional development support through mentoring and supervision during their first year of work along with organizations that provide ongoing competency assessment and continuing education are more likely to retain workers (Manzi et al., 2014; Moran et al., 2014; Zhang, Qian, Wu, Wen, & Hang, 2016). Positive supervisory and mentoring initiatives which foster effective workplace relationships between new and expert clinicians may be one strategy to effectively address the acute need to develop and strengthen human and institutional resources in order to allow people, governments and institutions (such as health care institutions) to reach measurable goals and achieve sustainable results when improving health (United Nations., 2006). In the face of critical staff shortages, mentoring has the potential to improve recruitment and retention in health care facilities in low and middle income countries (LMICs). A dedicated mentor or group of mentors combined with a culture of teaching and learning may attract more personnel to rural sites and keep them working in these communities for longer periods. The investment in mentors may pay for itself through decreased costs related to staff turnover, creation of career advancement pathways that help retain workers, and a reduction in medical errors resulting from short staffing (Willis-Shattuck et al., 2008). As a capacity building strategy for nursing and midwifery in Sub-Saharan Africa, it may also offer additional career advancement opportunities that can further enhance staff retention. This integrative review was inspired from a recent midwifery capacity building initiative that emphasized mentorship and supervisory development for midwives and nurses in a rural area of Tanzania (Ojemeni et al., 2017). The program resulted from a partnership between a large research intensive university based in the United States and non-profit with operations in northern Tanzania and management in the US. Expert clinicians and educators, with expertise in global health, were tasked to design and implement a five-day supervision and mentoring workshop for expert midwifery and nursing clinicians at two hospitals in the Lake Zone Region. In an effort to ground program goals and methods in best practices and the evidence, understanding the current understanding and presence of support and mentoring interventions in this region was essential to designing a program based on evidence and local context. This integrative review, conducted prior to program planning, generated findings that informed the design of the mentoring and preceptorship training program, with the broader goal of increasing professional capacity in low resource, maternity care settings in Africa. The results of this review are presented here.

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October 2017
62 Reads

A case study on building capacity to improve clinical mentoring and maternal child health in rural Tanzania: the path to implementation

DOI 10.1186/s12912-017-0252-0

BMC Nursing

Abstract Background: Tanzania is a low income, East African country with a severe shortage of human resources for health or health workers. This shortage threatens any gains the country is making in improving maternal health outcomes. This paper describes a partnership between Touch Foundation and NYU Rory Meyers College of Nursing - Global, aimed at improving clinical mentorship and capacity among nurses and midwives at two rural hospitals in the Tanzanian Lake Zone Region. Clinical mentoring capacity building and supportive supervision of staff has been shown to be a facilitator of retaining nurses and would be possible to acquire and implement quickly, even in a context of low resources and limited technology. Methods: A case study approach structures this program implementation analysis. The NYU Meyers team conducted a 6-day needs assessment at the two selected hospitals. A SWOT analysis was performed to identify needs and potential areas for improvement. After the assessment, a weeklong training, tailored to each hospitals’ specific needs, was designed and facilitated by two NYU Meyers nursing and midwifery education specialists. The program was created to build on the clinical skills of expert nurse and midwife clinicians and suggested strategies for incorporating mentoring and preceptorship as a means to enhance clinical safety and promote professional communication, problem solving and crisis management. Results: Nineteen participants from both hospitals attended the training. Fourteen of 19 participants completed a post training, open ended questionnaire for a 74% response rate. Fifty-seven percent of participants were able to demonstrate and provide examples of the concepts of mentorship and supervision 4 and 11 months’ post training. Participants indicated that while confidence in skills was not lacking, barriers to quality care lay mostly in understaffing. Implementation also offered multiple insights into contextual factors affecting sustainable program implementation. Conclusions: Three recommendations from this training include: 1) A pre-program assessment should be conducted to ascertain contextual relevance to curriculum development; 2) flexibility and creativity in teaching methods are essential to engage students; and 3) access to participants a priori to program implementation may facilitate a more tailored approach and lead to greater participant engagement. Keywords: HRH, Women’s health, Clinical mentorship, Nursing education & workforce, Tanzania

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September 2017
71 Reads

Pilot study of a multi-pronged intervention using social norms and priming to improve adherence to antiretroviral therapy and retention in care among adults living with HIV in Tanzania

https://doi.org/10.1371/journal.pone.0177394

Plos one

Background Interventions incorporating constructs from behavioral economics and psychology have the potential to enhance HIV ‘treatment as prevention’ (TasP) strategies. To test this hypothesis, we evaluated an intervention to improve antiretroviral therapy (ART) adherence based on the concepts of social norms and priming. Methods We used tools from marketing research and patient-centered design to develop a combination intervention that included visual feedback about clinic-level retention in care, a self-relevant prime, and useful take-home items with the priming image. The intervention was implemented at two HIV primary clinics in Shinyanga, Tanzania in 2-week intervals for six months. We conducted a quasi-experimental pilot study with a random sample of exposed and unexposed adult patients living with HIV infection (PLHIV) to compare retention and the proportion of patients with medication possession ratio (MPR) ≥95% after six months. Intervention acceptability was determined with a convenience sample of 405 PLHIV at baseline (n = 189) and endline (n = 216). Results Medical records were reviewed for 438 PLHIV (320 intervention, 118 standard of care). In adjusted analyses, PLHIV exposed to the intervention were significantly more likely to be in care after 6 months (87% vs. 79%, adjusted odds ratio (ORa) = 1.73, 95% CI: 1.08, 2.78, p<0.05) and were more likely to achieve MPR≥95% (70% vs. 59%, OR = 1.51, 95% CI: 0.96, 2.37, p = 0.07). The intervention was associated with increases in staff support of treatment goals (100% vs. 95%, p = 0.01) and life goals (66% vs. 50%, p<0.01), the perceived likelihood of other patients’ adherence (54% vs. 32%, p<0.01), support from other patients (71% vs. 60%, p = 0.03), and being very satisfied with care (53% vs. 35%, p<0.01). Conclusions This novel intervention has the potential to improve the clinic experience, short-term retention in care, and ART adherence. Future studies are needed to expand the generalizability of the approach and evaluate effectiveness on clinical outcomes.

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May 2017
70 Reads

Barriers and facilitators to enrollment and re-enrollment into the community health funds/Tiba Kwa Kadi (CHF/TIKA) in Tanzania: a cross-sectional inquiry on the effects of socio-demographic factors and social marketing strategies

DOI: 10.1186/s12913-017-2250-z

BMC Health Services Research

Background Introduction of a health insurance scheme is one of the ways to enhance access to health care services and to protect individuals from catastrophic health expenditures. Little is known on the influence of socio-demographic and social marketing strategies on enrollment and re-enrollment in the Community Health Fund/Tiba Kwa Kadi (CHF/TIKA) in Tanzania. Methods This cross-sectional study employed quantitative methods for data collection between November 2014 and March 2015 in Singida and Shinyanga regions. Relationship between variables was obtained through Chi-square test and multivariate logistic regression. Results We recruited 496 participants in the study. Majority (92.7%) of participants consented to participate, with 229 (49.8%) and 231 (50.2%) members and non members of CHF/TIKA respectively. Majority (90.9%) were aware of CHF/TIKA. Majority of CHF/TIKA members and non-members (90% and 68.3% respectively) reported health facility-based sensitization as the most common social marketing approach employed to market the CHF/TIKA. The most popular marketing strategies in the country including traditional dances, football games, radio, television, news papers, and mosques/church were reported by few CHF and non CHF members. Multivariate Logistic regression models revealed no significant association between social marketing strategies and enrollment, but only socio-demographics; including marital status (AOR = 2.0, 95% CI 1.1–3.8) and family size (household with ≥ 6 members) (AOR = 1.5, 95% CI 1.0–2.5), were significant factors associated with enrollment/re-enrollment rate. Conclusions This study indicated that low level of utilization of available social marketing strategies and socio-demographic factors are the barriers for attracting members to join the schemes. There is a need for applying various social marketing strategies and considering different facilitating and impending socio-demographic factors for the growth and sustainability of the scheme as we move towards universal health coverage. Keywords Social marketing Barriers Facilitators Community health funds Tanzania

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April 2017
84 Reads

Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania: a randomized trial

doi: 10.1097/QAD.0000000000001406

http://journals.lww.com/aidsonline

Objective: We evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy (ART) and retention in care among people living with HIV in Tanzania. Methods: At three clinics, 805 participants were randomized to three groups in a 3 : 3 : 1 ratio, stratified by site : nutrition assessment and counseling (NAC) and cash transfers (~$11/month, n = 347), NAC and food baskets (n = 345), and NAC-only (comparison group, n = 113, clinicaltrials.gov NCT01957917). Eligible people living with HIV were at least 18 years, initiated ART 90 days or less prior, and food insecure. Cash or food was provided for 6 or less consecutive months, conditional on visit attendance. The primary outcome was medication possession ratio (MPR) at least 95% at 6 months. Secondary outcomes were appointment attendance and loss to follow-up (LTFU) at 6 and 12 months. Results: The primary intent-to-treat analysis included 800 participants. Achievement of MPR at least 95% at 6 months was higher in the NAC + cash group compared with NAC-only (85.0 vs. 63.4%), a 21.6 percentage point difference [95% confidence interval (CI): 9.8, 33.4, P < 0.01]. MPR at least 95% was also significantly higher in the NAC + food group vs. NAC-only (difference = 15.8, 95% CI: 3.8, 27.9, P < 0.01). When directly compared, MPR at least 95% was similar in the NAC + cash and NAC + food groups (difference = 5.7, 95% CI: -1.2, 12.7, P = 0.15). Compared with NAC-only, appointment attendance and LTFU were significantly higher in both the NAC + cash and NAC + food groups at 6 months. At 12 months, the effect of NAC + cash, but not NAC + food, on MPR at least 95% and retention was sustained. Conclusion: Short-term conditional cash and food assistance improves ART possession and appointment attendance and reduces LTFU among food-insecure ART initiates in Tanzania. Copyright (C) 2017 Wolters Kluwer Health, Inc.

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January 2017
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Assessment of Maternal Mortality and its Associated Causes at Shinyanga Regional Hospital in Tanzania

DOI: 10.17795/whb-38976

The official Journal of Shiraz University of Medical Sciences

ackground: Maternal mortality remains a public health concern in low income countries particularly in sub-Saharan Africa where majority (62%) of maternal deaths occurs. In Tanzania maternal mortality ratio is as high as 432 deaths per 100,000 live births. Objectives: This study aimed to describe pattern of maternal mortality ratio and its associated causes at Shinyanga regional referral hospital. We also assessed the availability of the comprehensive emergency obstetric care services in the study setting. Methods: This was retrospective cross-sectional study which was conducted from April to May 2015 at Shinyanga Regional Referral Hospital. Information on demographic data, obstetric factors associated with maternal death and their causes as well as their management were extracted from the patient’s record file between 2010 and 2014 by using data extraction sheet. Data analysis was performed using SPSS version 18.0 for Windows (SPSS Inc, Chicago, IL, USA). Descriptive statistical analysis were summarized. Results: Overall maternal mortality ratio declined from 635/100,000 live births in 2010 to 449/100,000 live births in 2014. The main causes of maternal death were postpartum haemorrhage (50%) and pre-eclampsia/eclampsia (20%). Majority (77%) of the delays were encountered at hospital and at home (56%). Numerous forms of management were provided to women who experienced maternal death including C-section (35.5%) for antepartum haemorrhage and hysterectomy (17%) for postpartum haemorrhage. For pre-eclampsia/eclampsia, only 12.5% had C-section. Of all of the maternal deaths, only 2.5% had assisted vaginal delivery and 14% had puerperal sepsis. Conclusions: The observed maternal mortality ratio in this population is higher compared to the national average. Postpartum haemorrhage and preeclampsia/eclampsia remains to be the main direct causes of maternal deaths. Delay in decision making in seeking fortreatment and provision of treatment contributed to high maternal mortality observed in this study. This requires more effort to address the direct and indirect causes of maternal death. Keywords: Maternal Mortality; Risk Factors; Causes; Shinyanga; Tanzania

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October 2016
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The reality of task shifting in medicines management- a case study from Tanzania.

J Pharm Policy Pract 2015 6;8(1):13. Epub 2015 Apr 6.

Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.

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http://dx.doi.org/10.1186/s40545-015-0032-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394399PMC
April 2015
62 Reads
6 Citations

REFORMING SUPPORTIVE SUPERVISION OF MEDICINES MANAGEMENT WITH AN AUDIT TOOL IN PRIMARY HEALTH CARE FACILITIES: A CASE STUDY OF BAHI DISTR ICT, TANZANIA

Int J Pharm 2014 ; 4 ( 4 ): 108 - 114

International Journal of Pharmacy

Stock - out of essential medicines is a common problem in primary health facilities of Tanzania. Alternative approaches such as the use of auditing tools have been proposed in order to strengthen the generally weak supportive supervision in medicines management. A cross - sectional study was conducted in ten primary health facilities in Bahi District in Dodoma region - Tanzania between October and December, 2013. Standardized auditing tools and indicators were used to assess the availability of ten essential tracer medicines, timeliness and correctness of ordering, record keeping, documentation and financial management. Analysis was done by using MS Excel spreadsheet (Microsoft Excel ®, Microsoft Corporation). Mean availability of tracer medicines was 84%. Rapid Diagnostic Tests for malaria, artemether -lumefantrine, amoxicillin syrup and amoxicillin capsules were mostly found to be out of stock. Nine of the ten facilities submitted their ordering forms on time but only six of the ten facilities filled their ordering forms correctly. In five facilities, financial records did not balance with bank statements and receipt books. Medicines audits represent a feasible approach to strengthen medicines management at primary health facilities. The study validated standardized and simple tools that can be used to reform routine supportive supervision methodology. Key Words:Tanzania, health facilities, financial audit, supervision, medicines availability

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April 2014
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Provider-initiated HIV testing and counseling in Mbeya City, south-western Tanzania: knowledge and practice of health care providers.

Tanzan J Health Res 2011 Oct;13(4):95-100

Department of Health, Bahi District Council, PO Box 2993, Dodoma, Tanzania.

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October 2011
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Top co-authors

Josephine Borghi
Josephine Borghi

London School of Hygiene and Tropical Medicine

2
Fiona Chilunda
Fiona Chilunda

Health Promotion and System Strengthening Project

2
James Charles
James Charles

New Jersey Medical School

2
Sia E Msuya
Sia E Msuya

University of Oslo

2
Boniface Nguhuni
Boniface Nguhuni

National Institute for Infectious Diseases (INMI) "L. Spallanzani"

1
Prosper F Njau
Prosper F Njau

1918 University Avenue

1
William H Dow
William H Dow

School of Public Health

1
Sandra I McCoy
Sandra I McCoy

University of California

1
Siana Mapunjo
Siana Mapunjo

Ministry of Health and Social Welfare

1

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