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Aim: The study aimed to explore inspection practices of prescription handling and antibiotics control in the context of Tanzania’s community pharmacies. Design: Qualitative exploratory study. Methods: This qualitative study held 14 in-depth interviews with pharmacists (three), pharmaceutical technicians (seven), and pharmacy council representatives (four) to collect data on the inspection processes for regulating prescription handling and antibiotic control in community-based pharmacies. The data was then subjected to content analysis with the help of NVivo12. Results: The study found that even though routine inspections were conducted to regulate prescription handling and antibiotic control in community pharmacies, there were inconsistencies in prescription retention, inadequate documentation in the inventory system, and improper antibiotic storage, with less attention paid to inspecting antibiotic sales practices. Implicitly, the efficiency and effectiveness of such inspections were open to question. Moreover, many clients frequented these visits to community pharmacies without prescriptions, yet they were dispensed with non-over-the-counter antibiotics. Furthermore, there were generally disparities between regulatory expectations and practical implementation in community pharmacies. Conclusion: More emphasis is necessary on antibiotic prescriptions and retention in community pharmacies coupled with standardized inspection protocol to help enhance inspection regulation activities and promote better dispensing practices for prolonged medicine life, improved efficacy, and health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak. We aimed to analyse the prospects and challenges of the priority setting process for the elderly health care services following the 1990s health sector reforms in Tanzania. Methods: We conducted an exploratory case study on priority setting process for the elderly healthcare services in Igunga and Nzega Tanzania. We carried out 24 Key Informant Interviews (KIIs) with the positions of District medical officers, social welfare, Medical Officers in-charge (MOI), planning officers and health system information focal person. Additionally, we carried out two focus group discussions (FGDs), one from each district with six participants from each group. Participants for the FGDs were MOI, health secretary, representative members of Health Facility Governing Committee (HFGC) and Council Health Management Team (CHMT). Data were analyzed using the qualitative content analysis. Results: Two categories emerged from the analysis of the transcripts. These were the prospects and challenges in priority setting for the elderly population under the decentralized health sector in rural Tanzania. The prospects included; the capacity of the LGAs on priority setting; existence of strategies used by LGAs; availability of teamwork spirit and the existence of guidelines for priority setting at LGAs. The challenges included difficulties of elderly identification, insufficient resources to implement the planned activities at the LGAs, unintegrated digitalized government health information tools or programs at the LGAs, interference of LGAs by the Central Government and low interest of stakeholders on elderly health care. Conclusion: This study highlights the prospects and challenges facing priority setting for elderly care at the centralized health system in rural Tanzania. From the results the process is well organized but faces some challenges which if not addressed jeopardized and has potential to continue affecting the priority setting. Addressing the challenges highlighted requires joint efforts from both the elderly population in the community, healthcare providers and decision makers across all levels of the health system. This study serves as an eye-opener and calls for a bigger study to get a comprehensive picture of priority setting of the elderly health care in Tanzania. [ABSTRACT FROM AUTHOR]

Objectives Despite renewed interest in expansion of multi-tasked community health workers (CHWs) there is limited research on HIV and maternal health integration at the community-level. This study assessed the impact of integrating CHW roles for HIV and maternal health promotion on facility delivery utilization in rural Tanzania. Methods A 36-month time series data set (2014-2016) of reported facility deliveries from 68 health facilities in two districts of Tanzania was constructed. Interrupted time series analyses evaluated population-averaged longitudinal trends in facility delivery at intervention and comparison facilities. Analyses were stratified by district, controlling for secular trends, seasonality, and type of facility. Results There was no significant change from baseline in the average number of facility deliveries observed at intervention health centers/dispensaries relative to comparison sites. However, there was a significant 16% increase (p < 0.001) in average monthly deliveries in hospitals, from an average of 202-234 in Iringa Rural and from 167 to 194 in Kilolo. While total facility deliveries were relatively stable over time at the district-level, during intervention the relative change in the proportion of hospital deliveries out of total facility deliveries increased by 17.2% in Iringa Rural (p < 0.001) and 14.7% in Kilolo (p < 0.001). Conclusions for Practice Results suggest community-delivered outreach by dual role CHWs was successful at mobilizing pregnant women to deliver at facilities and may be effective at reaching previously under-served pregnant women. More research is necessary to understand the effect of dual role CHWs on patterns of service utilization, including decisions to use referral level facilities for obstetric care., Author(s): Katharine D. Shelley [sup.1] , Rose Mpembeni [sup.2] , Gasto Frumence [sup.3] , Elizabeth A. Stuart [sup.4] , Japhet Killewo [sup.2] , Abdullah H. Baqui [sup.1] , David H. [...]

Abstract Background The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce. Little is documented on how the post-reform training and deployment of medical doctors (MDs) have contributed to resolving Tanzania’s shortage of doctors. The study aims to assess achievements in training and deployment of MDs in Tanzania about 20 years since the 1990s health sector reforms. Methods We developed a human resource for health (HRH) conceptual model to study achievements in the training and deployment of MDs by using the concepts of supply and demand. We analysed secondary data to document the number of MDs trained in Tanzania and abroad, and the number of MDs recommended for the health sector from 1992 to 2011. A cross-sectional survey conducted in all regions of the country established the number of MDs available by 2011. Results By 1992, Tanzania had 1265 MDs working in the country. From 1992 to 2010, 2622 MDs graduated both locally and abroad. This translates into 3887 MDs by 2011. Tanzania needs between 3326 and 5535 MDs. Our survey captured 1299 MDs working throughout the country. This number is less than 40% of all MDs trained in and needed for Tanzania by 2011. Maldistribution favouring big cities was evident; the eastern zone with less than 30% of the population hosts more than 50% of all MDs. No information was available on the more than 60% of MDs uncaptured by our survey. Conclusions Two decades after the reforms, the number of MDs trained in Tanzania has increased sevenfold per year. Yet, the number and geographical distribution of MDs practicing in the country has remained the same as before the reforms. HRH planning should consider the three stages of health workforce development conceptualized under the demand and supply model. Auditing and improvement of the HRH database is highly recommended in dealing with Tanzania’s MD crisis.

Background: Microplanning is an important tool that health workers can use to ensure that immunization services reach every community. Through community participation, microplanning helped the health facility and communities to identify priority interventions, to address barriers, and to develop work plans with feasible solutions. Since 2017, Tanzania has implemented microplanning projects in poorly performing districts as a comprehensive approach to addressing Equity in immunization. Objective: The study explored the benefits and challenges of the implementation of microplanning in community-based health programs in vaccination services in Tanzania. Methods: This study employed a qualitative case study. In-depth interviews were used to obtain information from 22 key actors in the micro-planning process at the district, health facility and Community levels. Results: The study identified benefits of micro planning including engagement of stakeholders from the district to the community level and the creation of a sense of ownership of the Reach Every Child strategy at the community level. The study also revealed barriers to microplanning including delayed disbursement of funds to health facilities and the critical shortage of human resources for health. Conclusion: the implementation of microplanning at the health facility level has shown evidence of the theory of change indicating the paradigm shift from district dominant planning process to the involvement of local actors. [ABSTRACT FROM AUTHOR]