85 research outputs found
Economic development district funding
No full textJessica Metta, Executive Director, Mid-Columbia Economic Development District.Title from PDF caption (viewed on June 14, 2022).This archived document is maintained by the State Library of Oregon as part of the Oregon Documents Depository Program. It is for informational purposes and may not be suitable for legal purposes.Mode of access: Internet from the Oregon Government Publications Collection.Text in English
The effects of medicines availability and stock-outs on household's utilization of healthcare services in Dodoma region, Tanzania
No full textLow- and middle-income countries have been undertaking health finance reforms to address shortages of medicines. However, data are lacking on how medicine availability and stock-outs influence access to health services in Tanzania. The current study assesses the effects of medicine availability and stock-outs on healthcare utilization in Dodoma region, Tanzania. We conducted a cross-sectional study that combined information from households and healthcare facility surveys. A total of 4 hospitals and 89 public primary health facilities were surveyed. The facility surveys included observation, record review over a 3-month period prior to survey date, and interviews with key staff. In addition, 1237 households within the health facility catchment areas were interviewed. Data from the facility survey were linked with data from the household survey. Descriptive analysis and multivariate logistic regressions models were used to assess the effects of medicine availability and stock-outs on utilization patterns and to identify additional household-level factors associated with health service utilization. Eighteen medicines were selected as 'tracers' to assess availability more generally, and these were continuously available in ∼70% of the time in facilities across all districts over 3 months of review. The main analysis showed that household's healthcare utilization was positively and significantly associated with continuous availability of all essential medicines for the surveyed facilities [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.02-12.04; P = 0.047]. Healthcare utilization was positively associated with household membership in the community health insurance funds (OR 1.97, 95% CI 1.23-3.17; P = 0.005) and exposure to healthcare education (OR 2.75, 95% CI 1.84-4.08; P = 0.000). These results highlight the importance of medicine availability in promoting access to health services in low-income settings. Effective planning and medicine supply management from national to health facility level is an important component of quality health services
Health-seeking behaviour among adults in the context of the epidemiological transition in Southeastern Tanzania:A focus on malaria and diabetes
No full textHealth-seeking behaviour among adults in the context of epidemiological transition in Southeastern Tanzania: a focus on malaria and diabetes This study set out to assess cultural aspects shaping health-seeking behaviour for malaria and diabetes among adults in Tanzania, a country undergoing the epidemiological transition. The research was conducted in a rural district in which malaria has been a predominant cause of illness and which increasingly experiences diabetes as an emergent cause of ill health. The study examined how cultural aspects shape health-seeking behaviour. The theoretical insights of D’Andrade’s concept of Cultural Schemas and the Health Belief Model (HBM) were applied to guide a line of inquiry for the research.The study showed that malaria self-care is commonly practiced, which can be explained by the long-standing knowledge about the illness within this community. Unlike malaria, however, diabetes is a relatively new condition and the knowledge about its signs and symptoms is limited. People in this setting used the prevailing cultural meaning system regarding malaria to interpret the emerging diabetes symptoms. Anti-malarial medicines were often used as initial responses to diabetes symptoms. Failure by patients and health professionals to interpret the emerging symptoms frequently led to consultations with traditional healers and to association of the symptoms with witchcraft. Malaria services are easily accessed in the primary health facilities, whereas patients could hardly obtain diabetes services; this unavailability of services – and knowledge – proved to be an obstacle to the proper use of medication. The study shows that health-seeking behaviour for malaria and diabetes is shaped by cultural, individual, and health facility factors
Health-seeking behaviour among adults in the context of the epidemiological transition in Southeastern Tanzania:A focus on malaria and diabetes
No full textHealth-seeking behaviour among adults in the context of epidemiological transition in Southeastern Tanzania: a focus on malaria and diabetes This study set out to assess cultural aspects shaping health-seeking behaviour for malaria and diabetes among adults in Tanzania, a country undergoing the epidemiological transition. The research was conducted in a rural district in which malaria has been a predominant cause of illness and which increasingly experiences diabetes as an emergent cause of ill health. The study examined how cultural aspects shape health-seeking behaviour. The theoretical insights of D’Andrade’s concept of Cultural Schemas and the Health Belief Model (HBM) were applied to guide a line of inquiry for the research.The study showed that malaria self-care is commonly practiced, which can be explained by the long-standing knowledge about the illness within this community. Unlike malaria, however, diabetes is a relatively new condition and the knowledge about its signs and symptoms is limited. People in this setting used the prevailing cultural meaning system regarding malaria to interpret the emerging diabetes symptoms. Anti-malarial medicines were often used as initial responses to diabetes symptoms. Failure by patients and health professionals to interpret the emerging symptoms frequently led to consultations with traditional healers and to association of the symptoms with witchcraft. Malaria services are easily accessed in the primary health facilities, whereas patients could hardly obtain diabetes services; this unavailability of services – and knowledge – proved to be an obstacle to the proper use of medication. The study shows that health-seeking behaviour for malaria and diabetes is shaped by cultural, individual, and health facility factors
Health-seeking behaviour among adults in the context of the epidemiological transition in Southeastern Tanzania: A focus on malaria and diabetes
No full textHealth-seeking behaviour among adults in the context of epidemiological transition in Southeastern Tanzania: a focus on malaria and diabetes This study set out to assess cultural aspects shaping health-seeking behaviour for malaria and diabetes among adults in Tanzania, a country undergoing the epidemiological transition. The research was conducted in a rural district in which malaria has been a predominant cause of illness and which increasingly experiences diabetes as an emergent cause of ill health. The study examined how cultural aspects shape health-seeking behaviour. The theoretical insights of D’Andrade’s concept of Cultural Schemas and the Health Belief Model (HBM) were applied to guide a line of inquiry for the research. The study showed that malaria self-care is commonly practiced, which can be explained by the long-standing knowledge about the illness within this community. Unlike malaria, however, diabetes is a relatively new condition and the knowledge about its signs and symptoms is limited. People in this setting used the prevailing cultural meaning system regarding malaria to interpret the emerging diabetes symptoms. Anti-malarial medicines were often used as initial responses to diabetes symptoms. Failure by patients and health professionals to interpret the emerging symptoms frequently led to consultations with traditional healers and to association of the symptoms with witchcraft. Malaria services are easily accessed in the primary health facilities, whereas patients could hardly obtain diabetes services; this unavailability of services – and knowledge – proved to be an obstacle to the proper use of medication. The study shows that health-seeking behaviour for malaria and diabetes is shaped by cultural, individual, and health facility factors
The effects of Jazia prime vendor system in complementing the existing pharmaceutical supply chain across public healthcare facilities in Tanzania
No full textBackground: The availability of quality medicines in the provision of healthcare services is an integral part of universal health coverage (UHC). In low and middle-income countries (LMIC) the accessibility to essential medicines is often limited especially in peripheral healthcare facilities. The reasons for this situation include: - limited resources, weak transparency and poor accountability mechanisms in the pharmaceutical supply chain. These challenges have received substantial attention by health system researchers and health system strengthening initiatives. The focus has often been on interventions to establish public-private partnerships (PPP). The United Republic of Tanzania in 2014 started implementing a unique PPP, the Jazia prime vendor system (Jazia PVS), as a contracted private wholesaler supplier to complement the existing medicines supply chains in public facilities. The aim of this doctoral thesis was to analyse the Jazia prime vendor system.
Methods: A mixed-method research design was used to analyse the effect of the prime vendor system, in improving access to healthcare commodities in public healthcare facilities in Tanzania. The research combined household and health facility quantitative surveys with the qualitative research methods. Specifically, the thesis first assessed the effects of medicines availability and stock-outs on household’s utilisation of health care services. Second, it examined the role of accountability in the performance of the Jazia PVS. Third, it analysed how acceptability factors of the Jazia PVS affected shortages of essential medicines. Lastly, it estimated the costs and costs drivers of setting up a prime vendor system in the pilot regions and the predicted costs of national scale-up. A cross-sectional study that combined information from 1,237 households along a survey covering 89 public healthcare facilities was used for assessing the effects of medicines availability and stock-outs on household’s utilisation of health care services in Dodoma region. The household survey captured information on healthcare access and utilization, ownership of different assets, insurance and health promotion activities. On the other hand, the facility survey included observation of actual healthcare commodities available, record review over a three-month period before survey date, and interviews with key staff. Descriptive analysis and multivariate logistic regressions models were estimated to assess the effects of medicine availability and stock-outs on utilization patterns and to identify additional household-level factors associated with health service utilization. Framework analysis was adopted to summarise the results of accountability and acceptability experiences of Jazia PVS implementers using a deductive and inductive approaches. Data were drawn from, 14 focus group discussions (FGDs), 7 group discussion (GD) and 30 in-depth interviews (IDIs) with a range of persons involved in Jazia PVS. Lastly, a micro-costing approach was used to estimate costs and costs drivers for setting up a prime vendor system in the regions and model the national scale-up costs of the Jazia PVS in other regions.
Results: The results showed that household’s healthcare utilization was positively and significantly associated with continuous availability of essential medicines (odds ratio (OR): 3.49; 95% CI: 1.02-12.04; p~0.047). Healthcare utilization was positively associated with household membership in the community health insurance funds (OR, 1.97; 95% CI: 1.23-3.17; p~0.005) and exposure to health promotion (OR: 2.75; 95% CI: 1.84-4.08; p~0.000). Qualitative findings revealed that some accountability mechanisms implemented in conjunction with Jazia PVS contributed to the performance of Jazia PVS. These include inventory and financial auditing conducted by district pharmacists and the internal auditors, close monitoring of standard operating procedures by the prime vendor regional coordinating office and peer cascade coaching. Besides, the auditing activities allowed identifying challenges of delayed payment to the vendor and possible approaches for mitigation while peer cascade coaching played a crucial role in enabling staff at the primary facilities to improve skills to oversee and manage the medicines supply chain. The most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher-order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaborations with district managers and participants’ understanding that prime vendor was meant to complement the existing supply chain. The estimated Jazia PVS start-up financial costs amounted to US 605,060.13) while the health facility baseline assessment and the official launch of the Jazia PVS amounted to 5.4% (US 79,951.42) respectively. The economic start-up costs accounted for about 52.2% (US 741,836.55) was for staff and healthcare workers training. The Jazia PVS national roll-out costs amount to US 3,618,682.96). The current study provides evidence on the potentiality of the Jazia PVS in complementing existing pharmaceutical supply chain, indicating that such a model can be used to increase efficiency in the provision of services. LMICs interested in establishing PPP within the intension of improving healthcare delivery may adopt good lessons from the Jazia PVS in Tanzania. Nonetheless, strong capacity of various bodies to exercise oversight and sanctions in the implementation of the PPP is important in ensuring accountability linkages for the public and private entities.
In conclusion, these results highlight the importance of medicine availability in promoting access to health services in low-income settings. Effective planning and medicine supply management from national to health facility level is an important component of quality health services. In terms of accountability, it revealed that there is a need for capacity building linked to financial and supply management at lower-level health facilities, including health facility governing committees, which are responsible for priority-setting and decision-making at the facility level. PPP has the potential to improve service delivery; however, it is crucial to select a reputable and competent vendor, together with being loyal to the contractual agreement. Short-term experts, staff and health workers training comprised the largest component of Jazia PVS start-up costs. Integration of Jazia PVS into the existing regional and district administrative structures result in decreased implementation costs as no new structures were established and new staff deployed
Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania
No full textBackground: Pharmaceutical supply chain management in low- and middle-income countries has received substantial attention to address the shortage of medicines at peripheral facilities. The focus has been on health system interventions, including the establishment of public-private partnerships (PPPs). In 2014, the United Republic of Tanzania began implementing the Jazia prime vendor system (Jazia PVS) with a contracted private wholesale supplier to complement the national medicines supply chain in public facilities. Few studies have investigated the acceptability of such a prime vendor system. This study analyses factors that contributed to the acceptability of Jazia PVS introduced in Tanzania. We used qualitative analytical methods to study experiences of Jazia PVS implementers in 4 districts in mid-2018. Methods: Data were drawn from 14 focus group discussions (FGDs), 7 group discussions (GDs) and 30 in-depth interviews (IDIs) with a range of actors involved in Jazia PVS. The study analysed 7 acceptability dimensions as defined in the acceptability framework by Sekhon et al. Framework analysis was adopted to summarise the results using a deductive and an inductive approach. Results: The findings show that participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaboration with district managers, and participants’ understanding that the prime vendor was meant to complement the existing supply chain. Intervention coherence, experienced opportunity cost and intervention burden, affective attitude and self-efficacy were also important in explaining the acceptability of the Jazia PVS. Conclusion: In conclusion, the most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Districts purchasing directly from the prime vendor have a policy based on the possibility to increase availability of essential medicines at peripheral facilities in a low income setting; however, it is crucial to select a reputable and competent vendor, as well as to abide by the contractual agreements
Two Diverse Local Authors to Visit Campus
No full textAuthor Stephanie Elizondo Griest will visit Feb. 17 at 7 p.m. in Frances May Barnes Recital Hall. Poet Metta-Sáma Melvin\u27s visit is set for April 6 at 7 p.m. in Tuttle Dining Room
Predictors of mothers living with HIV uptake of HIV early infant diagnosis services in Iringa District, Tanzania
No full textBackground
Uptake of HIV early infant diagnosis (HEID) among HIV-exposed infants is the key to timely initiation of Antiretroviral Treatment (ART). However, despite the availability of HEID services in Tanzania, its uptake is low. We aimed to determine predictors of mothers living with HIV’ with HIV-exposed infants’ uptake of HEID services in Iringa District, Tanzania.
Methods
A health facility-based cross-sectional study was conducted in Iringa District from May to June 2023. Mothers with HIV-exposed infants were recruited in the study through a multistage sampling technique and interviewed using pre-tested structured questions. Logistic regression analysis was employed to determine potential predictors of HEID uptake.
Results
A total of 309 mothers with HIV-exposed infants participated in the study. About 78.3% of the HIV-exposed infants had initial DNA PCR for HEID within 6 weeks of age and 86.1% within 8 weeks. Most mothers had high perceived benefits on uptake of HEID with a mean score of 4.3, high perceived self-efficacy with a mean score of 3.8 and 2.7 perceived risk of HIV infection on their HIV-exposed infants on the 5 scale Likert scale with 5 showing the highest perceived benefit, self-efficacy and risk. High perceived self-efficacy and being a businesswoman were the predictors of uptake of HEID. The odds of self-efficacy on the uptake of HEID by 2.4 times (aOR 2.4 95% CI 1.6–3.2) within 6 weeks of age and 1.9 (aOR 1.9 95% CI 1.3-2.7) within 8 weeks. The odds of being a businesswoman were 0.4 for 6 weeks and 0.3 for 8 weeks (aOR 0.4 95% CI 0.2-0.8) and (aOR 0.3 95% CI 0.1-0.8) respectively.
Conclusion
Over three-quarters of the HIV-exposed infants had initial DNA PCR for HEID testing as recommended. Perceived self-efficacy was the main factor influencing HEID uptake. These findings highlight the need for strengthening HIV-positive mother's self-efficacy for improved uptake of HEID services
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