Browsing by Author "Muhanga, Mikidadi"

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Effects of decentralization on the functionality of health facility governing committees in lower and middle-income countries: a systematic literature review
(Taylor & Francis, 2022-05-02) Kesale, Anosisye M.; Mahonge, Christopher; Muhanga, Mikidadi
Background: Health facility governing committees (HFGCs) were established by lower and middle-income countries (LMICs) to facilitate community participation at the primary facility level to improve health system performance. However, empirical evidence on their effects under decentralization reform on the functionality of HFGCs is scant and inconclusive. Objective: This article reviews the effects of decentralization on the functionality of HFGCs in LMICs. Methods: A systematic literature review was conducted using various search engines to obtain a total number of 24 relevant articles from 14 countries published between 2000 and 2020. Inclusion criteria include studies must be on community health committees, carried out under decentralization, HFGCs operating at the individual facility, effects of HFGCs on health performance or health outcomes and peer-reviewed empirical studies conducted in LMICs. Results: The study has found varied functionality of HFGCs under a decentralization context. The study has found many HFGCs to have very low functionality, while a few HFGCs in other LMICs countries are performing very well. The context and decentralization type, members’ awareness of their roles, membership allowance and availability of resource to the facility in which HFGCs operate to produce the desired outcomes play a significant role in facilitating/ limiting them to effectively carry out the devolved duties and responsibilities. Conclusion: Fiscal decentralization has largely been seen as important in making health committees more autonomous, even though it does not guarantee the performance of HFGCs.
Factors influencing transient poverty among maasai pastoralists households in semi-arid areas of Simanjiro district, Tanzania
(The Sub-Saharan Journal of Social Sciences and Humanities (SSJSSH), 2022) Cosmas, Eutropia; Ngowi, Edwin; Ng’winamila, Kasongi; Muhanga, Mikidadi
There are two discourses on the feasibility of pastoralists’ livelihoods. The first maintained that pastoralism is still a feasible approach if suitable development ingenuities link rural households to markets. The second discloses the fact that pastoral livelihoods are depressed and unviable due to political side-lining, drought, and inadequate institutional support (markets and education). Consequently, poverty associated with the seasonal fluctuation of income (transient poverty) remains intense among pastoralists. This study determined factors influencing transient poverty among pastoralists in Simanjiro District, Tanzania. The study adopted a cross-sectional research design. Purposive and random sampling techniques were employed to select representative samples. Data collection methods comprised household surveys with 100 Maasai pastoralists, 4 focused group discussions (FGDs), and 20 key informants interviews. The regression model was used to determine the relationship between poverty and hypothesized-explanatory variables. The findings show that household heads who had never been to school have a higher likelihood of being trapped in transient poverty (statistically significant at p<0.05 in logistic regression). The herd size shows a significant effect on transient poverty i.e., the more the herd size the less likelihood of households being trapped in transient poverty holding other factors constant. Geographical proximity (distance to markets, water sources, and pasture fields) has a significant effect on transient poverty. The more the distance to markets, water sources, and pasture fields the higher the likelihood of households being trapped in transient poverty holding other factors constant. The poverty status of the household is highly associated with the level of physical access to markets, water sources, and pasture fields. Theoretically, the study contributes at different levels. First, contributes to the role of educational profile in transient poverty persistence, by showing how returns to education reduce transient poverty likelihood. Second, contributes to the factors for transient poverty, by showing the effect of geographical proximity on transient poverty. Lastly, contributes to the role of livelihoods diversification, by showing having multiple livelihoods strategies reduces transient poverty.
Health Literacy and Health Behaviour under One Health Approach in Tanzania: Connecting the Connected or Connecting the Unconnected?
(2020-10-10) Muhanga, Mikidadi
Globally, health literacy (HL) has been reported to stand as a driver to health behavioural changes. Despite efforts to educate people to enhance the knowledge and skills on health-related matters to improve health literacy, consequently enabling and encouraging individuals to make healthier lifestyle choices, sometimes, there has been notable health impairing behaviours. Definitely, in such circumstances, HL by itself has been observed to fail to drive such behavioural changes. This assumes that there are drivers together with or beyond HL towards behavioural changes. This cross-sectional study assessed HL and its influence on health behaviour (HB) under One Health Approach in Morogoro, Tanzania. A structured questionnaire was employed for data collection from 1440 respondents acquired through a multistage sampling procedure. A tool was developed to assess HL, an index of score gauged HB, and Likert scale was used to assess attitudes towards HB. Data were analyzed using IBM-SPSS v20 software. The study revealed, about one-third of the respondents (32.9%) had adequate HL, (30.8%) moderate HL and (36.3%) with inadequate HL; 40% had health-enhancing behaviours and 60% with health impairing behaviours. A significant association (health literacy*health behaviour, p=0.000; was observed. The results further revealed that 30% had unfavourable attitudes towards health impairing behaviours, and attitude was significantly found to associate with behaviours (p=0.000). It is concluded that attitudes towards health impairing behaviours affect the way HL can influence HB. This study recommends strengthening efforts to enhance health information dissemination through health education focusing on culture as the context that informs behaviours.
Health information systems utilization: a comparison of extent and magnitude in public and private health facilities in Dar es salaam, Tanzania
(American Journal of Humanities and Social Sciences Research (AJHSSR), 2023-03) Haule, Christiana D.; Muhanga, Mikidadi; Ngowi, Edwin
Health information systems (HISs) are critical tools that have been widely adopted and implemented in healthcare settings around the world, intending to improve the quality of healthcare services (OHSs) delivered. However, it is the extent and magnitude of HISs utilization that seem to guarantee improvement in the quality of health care. The study explored the extent to which HISs have been utilized in selected public and private health facilities (PPHFs) in Dar es Salaam, Tanzania, and the determinants of its utilization. A descriptive cross-sectional design was employed to collect data using the Kobo Collect survey tool from 140 respondents and 12 key informants. Descriptive statistics (frequencies and percentages), Inferential statistics (Pearson chi-square tests), and Linear regression analyses were employed to analyse data. The analysis revealed that private ownership has a higher utilization rate of HIS (61.4%) compared to public ownership (38.6%). Moreover, perceived ease of use and perceived usefulness were significant predictors of actual use of the system, suggesting that users who found the system easy to use and useful were more likely to use it. In conclusion, the utilization of HIS in Tanzania seems to be influenced by various factors, including ownership type.
Health Literacy and Health Behaviour under One Health Approach in Tanzania: Connecting the Connected or Connecting the Unconnected?
(Moshi University of Cooperatives, 2020-10-20) Muhanga, Mikidadi
Globally, health literacy (HL) has been reported to stand as a driver to health behavioural changes. Despite efforts to educate people to enhance the knowledge and skills on health-related matters to improve health literacy, consequently enabling and encouraging individuals to make healthier lifestyle choices,sometimes, there has been notable health impairing behaviours. Definitely, in such circumstances, HL by itself has been observed to fail to drive such behavioural changes. This assumes that there are drivers together with or beyond HL towards behavioural changes. This cross-sectional study assessed HL and its influence on health behaviou r (HB) under One Health Approach in Morogoro, Tanzania. A structured questionnaire was employed for data collection from 1440 respondents acquired through a multistage sampling procedure.A too l was developed to assess HL, an index of score gauged HB, and Likert scale was used to assess attitudes towards HB. Data were analyzed using IBM-SPSS v20 software. The study revealed, about one-third of the respondents (32.9%) had adequate HL, (30.8%) moderate HL and (36.3%) with inadequate HL; 40% had health-enhancing behaviours and 60% with health impairing behaviours. A significant association(health literacy*health behaviour, p=0.000;was observed. The results further revealed that 30% had unfavourable attitudes towards health impairing behaviours, and attitude was significantly foundto associate with behaviours (p=0.000).It is concluded that attitudes towards health impairing behaviours affect the way HL can influence HB.This study recommends strengthening efforts to enhance health information dissemination through health education focusing on culture as the context that informs behaviours
Prevalence and factors associated with early childbearing in Sub-Saharan Africa: evidence from demographic and health surveys of 31 countries
(Springer, 2023-08-14) Shasha, Liness; Phiri, Million; Namayawa, Sibongile; Sikaluzwe, Milika; Nakazwe, Chola; Lemba, Musonda; Muhanga, Mikidadi
Background Early childbearing remains a public health concern in sub-Saharan Africa (SSA) because it has substantial implications for women’s and children’s health and population control. However, little is known about recent changes in early childbearing in the region following the implementation of the Family Planning 2020 initiative (FP2020) national-level interventions. Thus, this study examined factors associated with early childbearing among women in SSA. Methods The study used data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2021. The analysis included a pooled sample of 54,671 parous young women aged 20–24 years. A multivariable binary logistic regression model was used to examine the association between early childbearing and individual and household-level factors. All analyses were weighted to account for complex survey design. Results The study shows that the mean prevalence of early childbearing was high in SSA at 39% (95% CI: 35, 43). Chad had the highest prevalence of early childbearing, 62% (95% CI: 60, 64) while Rwanda had the lowest prevalence of 13% (95% CI: 11, 15). Completing secondary school (aOR = 0.57; 95% CI: 0.52, 0.62) or attaining tertiary level education (aOR = 0.32; 95% CI: 0.22, 0.45), first sexual debut in the age range 15–24 years (aOR = 0.15; 95% CI: 0.14, 0.16) and desire for a small family size (aOR = 0.63; 95% CI: 0.58, 0.69) were associated with reduced odds of early childbearing among young women in SSA. Conclusion The study has established that the prevalence of early childbearing is high in SSA. Level of education, age at first sexual debut, household size, and desired family size are associated with early childbearing in SSA. Governments of SSA countries should enhance sexual and reproductive health interventions to change reproductive behaviour, particularly in adolescents and young women.
Public-private partnership supported health facilities and progress towards attainment of universal health coverage in Kilimanjaro, Tanzania
(Rwanda Journal of Medicine and Health Sciences, 2022) Kanti, Kimario; Kayunze, Kim; Muhanga, Mikidadi
Background Public-Private-Partnership-supported health facilities have been operational in Tanzania, and specifically, in Kilimanjaro since 1990s. This study provides a snapshot of the contribution of PPP-supported health facilities’ operations towards attainment of Universal Health Coverage (UHC) in Kilimanjaro region. Methods Adopting a cross-sectional research design, samples of 384 households and 30 health facilities were selected through a multi-stage and purposive sampling approaches, respectively. Questionnaires and key informant interviews (KIIs) were administered (June 2020 - February 2021). Using IBM-SPSS v.23, chi-square was used to compare PPP-supported and government health facilities’ service delivery quality and affordability. Content analysis was done on KIIs. Results With PPP-support unweighted mean index score for service availability (SA) was 46.59% and 29.14% without PPP-supported health facilities. With PPP-support, the GSR index score was 87% while it was 82% without PPP-support. This implies, with PPP-support, progress towards UHC attainment can be accelerated. There was no significant association between accessing services in PPP-supported or government health facilities by perceived service delivery quality and service affordability. Conclusion PPP-supported and government health facilities co-existence is essential at hastening the progress towards UHC in the study area. The government should strengthen policies and regulations to promote more PPPs in improving health facilities’ operations.
Public-private partnerships in the provision of healthcare services for sustainable development in Tanzania: A systematic literature review
(2020-10-10) Kimario, Kanti; Kayunze, Kim; Muhanga, Mikidadi
This article reviews the literature on the concept and practice of public-private partnership (PPP). Specifically, the paper reviews theoretical aspects of the concept and practice of PPP and the rationale and potential of PPP in the provision of healthcare services for sustainable development in Tanzania. Using a documentary review research method, different search engines and databases were used in information search from peer-reviewed journals, conference papers, among others. The search strategy involved keywords such as 'Tanzanian healthcare', 'healthcare', 'health insurance', 'public-private partnerships', 'sustainable healthcare provision' and 'sustainable development goals'.The literature search identified a total of 1,600 articles associated with a set of specific search terms. Only fifty (50) studies met the final criteria for review. Articles included were those published from the year 2000 to the present. PPPs are potentially essential tools to increase the delivery of public goods and services because the private sector is capable of complementing resources from the government. Private sector investors can substantially participate in the achievement of SDGs by complementing the available public physical and non-physical resources such as finances, expertise, health sector workforce, and readiness for risk-taking. PPP in the health sector needs to be promoted because sustainable development needs a healthy population, which needs access to essential healthcare services to live healthily
The functionality of health facility governing committees and their associated factors in selected primary health facilities implementing direct health facility financing in Tanzania: a mixed‐method study
(Wiley, 2022-03-22) Kesale, Anosisye Mwandulusya; Mahonge, Christopher Paul; Muhanga, Mikidadi
Background: In Lower and Middle‐Income Countries (LMICs), decentralization has dominated the agenda for reforming the organization of service delivery (LMICs). The fiscal decentralization challenge is a hard one for decentralization. As they strive to make decisions and use health facility funding, primary healthcare facilities encounter the obstacles of fiscal decentralization. LMICs are currently implementing fiscal decentralization reforms to empower health facilities and their Health Facility Governing Committees (HFGCs) to improve service delivery. Given the scarcity of systematic evidence on the impact of fiscal decentralization, this study examined the functionality of HFGCs and their associated factors in primary healthcare facilities in Tanzania that were implementing fiscal decentralization through Direct Health Facility Financing (DHFF). Methods: To collect both qualitative and quantitative data, a cross‐sectional approach was used. The research was carried out in 32 primary healthcare facilities in Tanzania that were implementing the DHFF. A multistage sample approach was utilized to pick 280 respondents, using both probability and nonprobability sampling procedures. A structured questionnaire, in‐depth interviews, and focus group discussions were used to gather data. The functionality of HFGCs was determined using descriptive analysis, and associated factors for the functioning of HFGCs were determined using binary logistic regression. Thematic analysis was used to do qualitative research. Result: HFGC functionality under DHFF has been found to be good by 78.57%. Specifically, HFGCs have been found to have good functionality in mobilizing communities to join Community Health Funds 87.14%, participating in the procurement process 85%, discussing community health challenges 81.43% and planning and budgeting 80%. The functionality of HFGCs has been found to be associated with the planning and budgeting aspects p value of 0.0011, procurement aspects p value 0.0331, availability of information reports p value 0.0007 and Contesting for HFGC position p value 0.0187. Conclusion: The study found that fiscal decentralization via DHFF increases the functionality of HFGCs significantly. As a result, the report proposes that more effort be placed into making financial resources available to health facilities.
Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001–2018)
(BMC, 2024) Sikaluzwe, Milika; Phiri, Million; Lemba, Musonda; Shasha, Liness; Muhanga, Mikidadi
Background Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. Methods This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15–49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. Results Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25–29 years and 30–34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. Conclusions The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women’s age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.
The what, why, and how of health information systems: a systematic review
(The Sub-Saharan Journal of Social Sciences and Humanities (SSJSSH), 2022) Haule, Christiana D.; Muhanga, Mikidadi; Ngowi, Edwin
The literature on the topic of health information systems (HISs) is reviewed in this paper. Specifically, the paper reviews the literature on (i) the theoretical concept of HISs (The What), (ii) the rationale, purposes, and importance (The Why), and (iii) the operationalization of the HISs (The How). For this systematic review, we searched Research Gate, Science Direct, Google Scholar, JSTOR, ProQuest, Scopus, PMC, BMJ, PubMed, and published documents by World Health Organization (WHO). Only 35 articles out of 1,400 articles identified were included in the study depending on the 3 contextualised questions i.e., the what, why, and how of the HISs. Literature published between 1960 and 2021 were considered in the review as the concept of HIS was introduced in the 1960s, excluding literature published before the 1960s and non-English publications. Generally, the HISs is one of the six pillars that make up a strong health system, designed to collect, process, store and manage health information. The main goal of the HISs is to deliver quality services. The importance of these systems includes quick access to medical records, sharing of patient information, reducing paperwork, reducing medical errors, improve the quality of care. Therefore, there is a great need to promote this concept, taking into account its rationale, purposes, and importance of it in the health care system.