Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania

International Journal of Women's Health, Volume 13, Year 2021

Interpretation

Background: Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania. Methods: This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation. Results: Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders’ engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor. Conclusion: Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation. This study was conducted in Pangani district, geographically located in northeast Tanzania. The district is generally rural, and according to the 2012 Tanzania Population and Housing Census, it had a population of 54,025 people. The female population numbers 27,155, which is 50.27% of the total population, with an average household size of approximately 4 persons. The population density was 24 persons per square kilometre, with about 21% of the population living in a semi-urban centre. The main social-economic activities are cash crops, food crops, livestock keeping, poultry keeping, fishing, and small-scale industries. In February 2018, Tanzania officially launched the DHFF system policy.47 This policy aims to devolve planning, budgeting, and implementation responsibilities to primary health providers. The program was introduced to meet the following goals: improving the structural quality of maternal and child health services, increasing accountability and governance in the health system at the primary health-care facilities, facilitating increasing health system responsiveness to patients who receive health-care in the respective health facilities, and improving health-seeking behaviour and service utilisation at the primary health facility level.41,48 This is a marked departure from the previous system where planning and budgeting were done by DMOs. Another aim of the DHFF is to improve the sense of community ownership of health-care provision by including community representatives in health facility governing committees.47,49 Under the DHFF program, the Council Health Service Boards and health facility governing committees have been given the primary responsibility to undertake planning, budgeting, and implementing health service delivery at the local level.47,49 Before the DHFF, disbursement of funds to Primary Health facilities passed through 2 levels; from the central government through the Ministry of Finance and Planning to the President’s Office-Regional Administration and Local Government and then the respective Local Government Authorities.41,50 Under local government authorities, the DMOs received the health budgeted funds, and disbursed the funds to primary health-care facilities.51 Delays were sometimes encountered in disbursements of the funds by DMOs, which negatively impacted the delivery of health services, including those for vulnerable women and led to negatively impacted service delivery by consumers.47,52 The DHFF system acts as a bridge between central government (Ministry of Finance and Planning) and local government authorities the primary health facilities in which funds are directly transferred from the Ministry of Finance and planning to frontline primary health facilities.53 The shift aimed to increase service delivery efficiency by reducing leakages and enhancing predictability and timeliness of funds received at primary health facilities.41,54 PlanRep is a planning and reporting database used by local government authorities during planning and reporting, facility budget is governed by previous financial year annual revenue collection as budget sealing cut off point from central government to local government and partly is driven by consideration of population size of respective health facilities.53,54 In the four-year lifespan of the DHFF in Pangani, there has not been a thorough assessment of its impact on maternal health services.47 This study attempts to make such an evaluation, and we consider that the implementation of the DHFF is timely to improve the quality of and access to maternal health services. Under the DHFF, the facility therapeutic committee must consider previous stock and available funds when planning the procurement of maternal drugs such as folic acids, iron supplements, magnesium sulphate, and sulfadoxine-pyrimethamine (SP) for malaria treatment; medical reagents such as syphilis test, malaria rapid diagnostic test, and deep urine stick for protein; medical equipment like blood pressure machine, weighing scale machine, fetal scope, and delivery kit. The facility pharmacist prepares the Medical Stores Department (MSD) orders through an electronic logistic management information system. Once approved by the medical officer in charge of the facility, the order is sent to MSD. MSD prepares a pro forma invoice for available and out-of-stock items, which are then sent to the facility for payment of available items. Out-of-stock items are sourced from approved private vendors by the procurement management unit, which issues a local purchase order to the vendor.55 Once the facility therapeutic committee and community health governing committees approve items delivered by the vendor, payment is then made. This study used a mixed-methods approach, utilizing both qualitative and quantitative data. The qualitative data were based on interviews and focus groups, hence consistent with the Consolidated Criteria for Reporting Qualitative Research (COREQ).56 The quantitative data compared births occurred at health facilities before and after the DHFF intervention. The study the used financial year 2016/2017 as a source for baseline data for the period before introducing DHFF and the financial year 2017/2018 as the follow-up year after the intervention. To evaluate outcome on facility deliveries, availability of essential drugs, medical equipment, and reagents for maternal health and quality of care provided for maternal health, fidelity of implementation framework57–59 was used. The study was implemented based on the structured conceptual framework as shown in Figure 1. The framework was adapted from Ntuli’s47 to enable the establishment of the effect pathway relationship to determine the trend and progress of DHFF interventions. Theoretical framework for DHFF implementation in the study area. The study used a purposive sampling approach with stratification to select participants from five5 health facilities, namely, Pangani district hospital, Mwera health center, and three dispensaries: Masaika, Kwakibuyu, and Mkalamo. A reason for choosing these facilities was to have a representative sample of health facilities across different levels of service provision at the district level: hospital, health center, and dispensary. Also, the study selected these facilities because they had a high volume of deliveries compared with others of the same level within the district. Therefore, the choice of these facilities enabled us to access a large quantity of information related to our study objectives. The number of deliveries from the facilities before HDFF (2016/17) and one year thereafter (ie, 2017/18) was 1189 and 1589, respectively (Table 1). Number of units of different medical supplies, equipment and reagents are shown in Table 2. Status of Facility Deliveries Before and After the DHFF Implementation in Pangani District Notes: “A” represents financial year 2016/17 and “B” represents financial year 2017/18. P-value <0.05 indicates that the difference is statistically significant. Status of Medical Supplies, Medical Equipment, and Medical Reagents Before and After the DHFF Implementation in Pangani District Notes: “A” represents financial year 2016/17 and “B” represents financial year 2017/18. P-value <0.05 is statistically significant. Data collection procedures for both quantitative and qualitative data involved visiting each study facility and meeting all key participants and key informants to capture information relevant to the study objectives. This was consistent with the principles for process evaluation and mixed methods research.60 Quantitative data were collected to assess changes over time from facility registry for 2016/2017 as a baseline year before the introduction of DHFF and 2017/2018 as follow-up year after the DHFF intervention was implemented. Health-care workers and health governing committee members from each study facility were interviewed based on their experiences before and after introduction of DHFF to describe changes over time. The qualitative data was collected by interviewing the key informants, through in-depth interviews and focus group discussions (FGDs). The reason why we have conducted qualitative part of our study is to explore the reality of DHFF system implementation success and challenges direct from primary health facilities. During the development of the questionnaire and interview guide, different steps were taken as stated below: Participants were informed and consented to the publication of anonymised responses. Data collection tools were piloted for five days by the research team in Bagamoyo district. The district was selected for the pilot survey because it is similar in characteristics with Pangani district where the actual study was conducted. All challenges and observations noted during the pilot survey were addressed before the actual field data collection. Qualitative data analysis was undertaken using a framework grouping of relevant themes that answers key issues as per study objectives. Transcripts were managed and coded in NVIVO 11 by the use of the framework analysis approach.61 Coded data were reviewed, organized into charts according to research themes focusing on the study objectives and emerging issues from the interviews. After development of the questionnaire and interview guide, different purposive selections of respondents were selected in different sites. After obtaining their consent, we conducted interview using the entire respective questionnaire and interview guide. During this pilot/pre-testing we identified questions that needed to be adjusted and/or improved. At each facility, the study extracted retrospective information from the health facilities’ information system books: book number 4 – ledger book, book number 6 – antenatal care register, book number 12 – labors, and delivery book, and book number 13 – postnatal register. Data was also extracted from the facility Health Management Information System registry. The variables recorded were services provided, medical equipment, maternal drugs, and maternal medical reagents. This study conducted 16 In-depth Interviews (IDIs) with health-care workers and 5 Focus Group Discussions (FGDs), which comprised 8–12 participants. The participants were community health governing committee members from each facility. The principal investigator (ie, Samwel Tukay) used a guiding tool during the collection of qualitative data. There was no prior relationship between the participants and the research team. The investigator took notes during IDIs, and FGDs sessions and all sessions were audio-recorded to facilitate transcription of the information. Digital recordings of interviews were made and transcribed in Kiswahili and then translated to English. The study used digital voice recorder, pen, pencils, and notebooks to capture participants’ information and critical issues to answer research objectives. All the audio interviews were transported from the audio recorders to the laptop for further processing. All the interviews were transcribed word for word by the researcher. After transcription, all the transcripts were cross-checked in relation to the audio recording to ensure all the information have been captured correctly as it is in the audio without omission of any information. All the correct transcripts were then translated from Swahili to English by an experienced translator, and all the translated transcripts were also checked for clarity before analysis. The quantitative data analysis was done descriptively using Stata (version 12) statistical software. The number of deliveries and those of different medical supplies, equipment, and reagents were compared before and after DHFF implementation using a two-sample test of proportions. Qualitative data analysis was undertaken using framework analysis. We grouped relevant themes that answer key issues as per study objectives. Coded data were reviewed, organized into tables according to research themes focusing on the study objectives and issues emerging from the interviews. Further details about the coding are presented in the data analysis by framework grouping (Table 3). Data Analysis by Framework Grouping

AI Digest

Study Justification:

– Maternal morbidity and mortality are significant public health concerns globally, with Tanzania reporting high rates of maternal deaths.
– Sub-national level data is needed to understand the specific challenges and disparities in maternal health services in rural areas like Pangani district.
– The study aims to evaluate the impact of the Direct Health Facility Financing (DHFF) program on the quality of maternal health services in Pangani district.

Study Highlights:

– The DHFF program reduced delays in procurement, improved community outreach services, and increased community leaders’ engagement.
– Deliveries occurring at health facilities increased by 33.6% after the implementation of DHFF.
– The availability of medical supplies, equipment, and reagents for maternal health services also increased significantly.

Study Recommendations:

– Strengthen the DHFF system to address challenges such as lack of computers, poor internet connectivity, and limited knowledge of staff about the system.
– Improve the supply of medical equipment and stabilize the stock of the Medical Stores Department.
– Provide in-service and on-the-job training for health staff to enhance the implementation of the DHFF system.

Key Role Players:

– Council Health Management Teams
– Facility In Charges
– Maternity Nurse in Charge
– Community Health Governing Committee Members

Cost Items for Planning Recommendations:

– Computers and internet connectivity
– Medical equipment
– Medical supplies (drugs, delivery kits, reagents)
– Training programs for health staff

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, but there are some areas for improvement. The study used both qualitative and quantitative methods, which adds to the robustness of the findings. The increase in facility deliveries by 33.6% after the implementation of the DHFF is statistically significant. The study also highlights the positive impact of the DHFF on the procurement process and community engagement. However, to improve the evidence, the study could have included a larger sample size and conducted a more comprehensive assessment of the impact of the DHFF on maternal health services. Additionally, addressing the limitations mentioned in the abstract, such as the lack of computers and poor internet connectivity, inadequate supply of medical equipment, and limited knowledge of the staff about the system, would further strengthen the evidence.

Abstract

This study was conducted in Pangani district, geographically located in northeast Tanzania. The district is generally rural, and according to the 2012 Tanzania Population and Housing Census, it had a population of 54,025 people. The female population numbers 27,155, which is 50.27% of the total population, with an average household size of approximately 4 persons. The population density was 24 persons per square kilometre, with about 21% of the population living in a semi-urban centre. The main social-economic activities are cash crops, food crops, livestock keeping, poultry keeping, fishing, and small-scale industries. In February 2018, Tanzania officially launched the DHFF system policy.47 This policy aims to devolve planning, budgeting, and implementation responsibilities to primary health providers. The program was introduced to meet the following goals: improving the structural quality of maternal and child health services, increasing accountability and governance in the health system at the primary health-care facilities, facilitating increasing health system responsiveness to patients who receive health-care in the respective health facilities, and improving health-seeking behaviour and service utilisation at the primary health facility level.41,48 This is a marked departure from the previous system where planning and budgeting were done by DMOs. Another aim of the DHFF is to improve the sense of community ownership of health-care provision by including community representatives in health facility governing committees.47,49 Under the DHFF program, the Council Health Service Boards and health facility governing committees have been given the primary responsibility to undertake planning, budgeting, and implementing health service delivery at the local level.47,49 Before the DHFF, disbursement of funds to Primary Health facilities passed through 2 levels; from the central government through the Ministry of Finance and Planning to the President’s Office-Regional Administration and Local Government and then the respective Local Government Authorities.41,50 Under local government authorities, the DMOs received the health budgeted funds, and disbursed the funds to primary health-care facilities.51 Delays were sometimes encountered in disbursements of the funds by DMOs, which negatively impacted the delivery of health services, including those for vulnerable women and led to negatively impacted service delivery by consumers.47,52 The DHFF system acts as a bridge between central government (Ministry of Finance and Planning) and local government authorities the primary health facilities in which funds are directly transferred from the Ministry of Finance and planning to frontline primary health facilities.53 The shift aimed to increase service delivery efficiency by reducing leakages and enhancing predictability and timeliness of funds received at primary health facilities.41,54 PlanRep is a planning and reporting database used by local government authorities during planning and reporting, facility budget is governed by previous financial year annual revenue collection as budget sealing cut off point from central government to local government and partly is driven by consideration of population size of respective health facilities.53,54 In the four-year lifespan of the DHFF in Pangani, there has not been a thorough assessment of its impact on maternal health services.47 This study attempts to make such an evaluation, and we consider that the implementation of the DHFF is timely to improve the quality of and access to maternal health services. Under the DHFF, the facility therapeutic committee must consider previous stock and available funds when planning the procurement of maternal drugs such as folic acids, iron supplements, magnesium sulphate, and sulfadoxine-pyrimethamine (SP) for malaria treatment; medical reagents such as syphilis test, malaria rapid diagnostic test, and deep urine stick for protein; medical equipment like blood pressure machine, weighing scale machine, fetal scope, and delivery kit. The facility pharmacist prepares the Medical Stores Department (MSD) orders through an electronic logistic management information system. Once approved by the medical officer in charge of the facility, the order is sent to MSD. MSD prepares a pro forma invoice for available and out-of-stock items, which are then sent to the facility for payment of available items. Out-of-stock items are sourced from approved private vendors by the procurement management unit, which issues a local purchase order to the vendor.55 Once the facility therapeutic committee and community health governing committees approve items delivered by the vendor, payment is then made. This study used a mixed-methods approach, utilizing both qualitative and quantitative data. The qualitative data were based on interviews and focus groups, hence consistent with the Consolidated Criteria for Reporting Qualitative Research (COREQ).56 The quantitative data compared births occurred at health facilities before and after the DHFF intervention. The study the used financial year 2016/2017 as a source for baseline data for the period before introducing DHFF and the financial year 2017/2018 as the follow-up year after the intervention. To evaluate outcome on facility deliveries, availability of essential drugs, medical equipment, and reagents for maternal health and quality of care provided for maternal health, fidelity of implementation framework57–59 was used. The study was implemented based on the structured conceptual framework as shown in Figure 1. The framework was adapted from Ntuli’s47 to enable the establishment of the effect pathway relationship to determine the trend and progress of DHFF interventions. Theoretical framework for DHFF implementation in the study area. The study used a purposive sampling approach with stratification to select participants from five5 health facilities, namely, Pangani district hospital, Mwera health center, and three dispensaries: Masaika, Kwakibuyu, and Mkalamo. A reason for choosing these facilities was to have a representative sample of health facilities across different levels of service provision at the district level: hospital, health center, and dispensary. Also, the study selected these facilities because they had a high volume of deliveries compared with others of the same level within the district. Therefore, the choice of these facilities enabled us to access a large quantity of information related to our study objectives. The number of deliveries from the facilities before HDFF (2016/17) and one year thereafter (ie, 2017/18) was 1189 and 1589, respectively (Table 1). Number of units of different medical supplies, equipment and reagents are shown in Table 2. Status of Facility Deliveries Before and After the DHFF Implementation in Pangani District Notes: “A” represents financial year 2016/17 and “B” represents financial year 2017/18. P-value <0.05 indicates that the difference is statistically significant. Status of Medical Supplies, Medical Equipment, and Medical Reagents Before and After the DHFF Implementation in Pangani District Notes: “A” represents financial year 2016/17 and “B” represents financial year 2017/18. P-value <0.05 is statistically significant. Data collection procedures for both quantitative and qualitative data involved visiting each study facility and meeting all key participants and key informants to capture information relevant to the study objectives. This was consistent with the principles for process evaluation and mixed methods research.60 Quantitative data were collected to assess changes over time from facility registry for 2016/2017 as a baseline year before the introduction of DHFF and 2017/2018 as follow-up year after the DHFF intervention was implemented. Health-care workers and health governing committee members from each study facility were interviewed based on their experiences before and after introduction of DHFF to describe changes over time. The qualitative data was collected by interviewing the key informants, through in-depth interviews and focus group discussions (FGDs). The reason why we have conducted qualitative part of our study is to explore the reality of DHFF system implementation success and challenges direct from primary health facilities. During the development of the questionnaire and interview guide, different steps were taken as stated below: Participants were informed and consented to the publication of anonymised responses. Data collection tools were piloted for five days by the research team in Bagamoyo district. The district was selected for the pilot survey because it is similar in characteristics with Pangani district where the actual study was conducted. All challenges and observations noted during the pilot survey were addressed before the actual field data collection. Qualitative data analysis was undertaken using a framework grouping of relevant themes that answers key issues as per study objectives. Transcripts were managed and coded in NVIVO 11 by the use of the framework analysis approach.61 Coded data were reviewed, organized into charts according to research themes focusing on the study objectives and emerging issues from the interviews. After development of the questionnaire and interview guide, different purposive selections of respondents were selected in different sites. After obtaining their consent, we conducted interview using the entire respective questionnaire and interview guide. During this pilot/pre-testing we identified questions that needed to be adjusted and/or improved. At each facility, the study extracted retrospective information from the health facilities’ information system books: book number 4 – ledger book, book number 6 – antenatal care register, book number 12 – labors, and delivery book, and book number 13 – postnatal register. Data was also extracted from the facility Health Management Information System registry. The variables recorded were services provided, medical equipment, maternal drugs, and maternal medical reagents. This study conducted 16 In-depth Interviews (IDIs) with health-care workers and 5 Focus Group Discussions (FGDs), which comprised 8–12 participants. The participants were community health governing committee members from each facility. The principal investigator (ie, Samwel Tukay) used a guiding tool during the collection of qualitative data. There was no prior relationship between the participants and the research team. The investigator took notes during IDIs, and FGDs sessions and all sessions were audio-recorded to facilitate transcription of the information. Digital recordings of interviews were made and transcribed in Kiswahili and then translated to English. The study used digital voice recorder, pen, pencils, and notebooks to capture participants’ information and critical issues to answer research objectives. All the audio interviews were transported from the audio recorders to the laptop for further processing. All the interviews were transcribed word for word by the researcher. After transcription, all the transcripts were cross-checked in relation to the audio recording to ensure all the information have been captured correctly as it is in the audio without omission of any information. All the correct transcripts were then translated from Swahili to English by an experienced translator, and all the translated transcripts were also checked for clarity before analysis. The quantitative data analysis was done descriptively using Stata (version 12) statistical software. The number of deliveries and those of different medical supplies, equipment, and reagents were compared before and after DHFF implementation using a two-sample test of proportions. Qualitative data analysis was undertaken using framework analysis. We grouped relevant themes that answer key issues as per study objectives. Coded data were reviewed, organized into tables according to research themes focusing on the study objectives and issues emerging from the interviews. Further details about the coding are presented in the data analysis by framework grouping (Table 3). Data Analysis by Framework Grouping

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Strengthening the DHFF system: The study highlights the positive impact of the Direct Health Facility Financing (DHFF) program on maternal health service delivery. To maximize its impact, it is recommended to strengthen the DHFF system by addressing challenges such as lack of computers, poor internet connectivity, and limited knowledge of the staff about the system. This could involve providing training and resources to health facility staff to ensure smooth implementation of the DHFF program.

2. Improving health workforce: The study identifies inadequate health workforce as a challenge that needs to be addressed. To improve access to maternal health services, it is important to address the shortage of skilled health workers in the Pangani district. This could involve recruiting and training more health workers, particularly those with expertise in maternal health, to ensure that there are enough personnel to provide quality care to pregnant women.

3. Enhancing community engagement: The DHFF program aims to improve community ownership of healthcare provision by including community representatives in health facility governing committees. To further enhance community engagement, it is recommended to strengthen the role of community health governing committees and promote community participation in decision-making processes related to maternal health services. This could involve conducting awareness campaigns and community outreach programs to educate and involve community members in maternal health initiatives.

4. Improving supply chain management: The study highlights the importance of timely procurement of medical supplies, equipment, and reagents for maternal health services. To ensure a steady supply of essential items, it is recommended to improve supply chain management systems. This could involve implementing electronic logistic management information systems, establishing partnerships with reliable suppliers, and strengthening coordination between health facilities and the Medical Stores Department.

5. Enhancing infrastructure and technology: The study mentions challenges related to the lack of computers and poor internet connectivity, which can hinder the implementation of the DHFF program. To overcome these challenges, it is recommended to invest in infrastructure and technology. This could involve providing health facilities with computers, improving internet connectivity, and ensuring that facilities have access to reliable electricity supply.

These innovations have the potential to improve access to maternal health services in the Pangani district of Tanzania, as highlighted by the findings of the study. By addressing the identified challenges and implementing these recommendations, it is possible to enhance the quality and availability of maternal health services, ultimately reducing maternal morbidity and mortality rates.

AI Innovations Description

Based on the evaluation of the Direct Health Facility Financing (DHFF) program in improving maternal health services in Pangani District, Tanzania, the following recommendations can be developed into innovations to improve access to maternal health:

1. Strengthen the DHFF system: Address the lack of computers and poor internet connectivity, as well as the insufficient supply of medical equipment and unstable stock of the Medical Stores Department. This can be done by investing in reliable internet infrastructure, providing necessary medical equipment, and ensuring a consistent supply of essential medical supplies.

2. Staff training: Provide in-service and on-the-job training for healthcare staff to enhance their knowledge and skills in implementing the DHFF system. This will ensure smooth implementation and maximize the impact of the program.

3. Improve health workforce: Address the inadequate health workforce by recruiting and training additional healthcare professionals, particularly in rural areas where access to maternal health services may be limited. This will help meet the increased demand for services resulting from the DHFF program.

4. Community engagement: Continue to involve community representatives in health facility governing committees to improve community ownership of healthcare provision. This will enhance accountability and governance in the health system and promote health-seeking behavior among community members.

5. Expand the DHFF program: Consider expanding the DHFF program to other districts and regions in Tanzania to improve access to maternal health services on a broader scale. This can be done by replicating the successful implementation strategies and adapting them to the specific contexts of different areas.

By implementing these recommendations, the DHFF program can be further developed into an innovation that effectively improves access to maternal health services, reduces maternal morbidity and mortality, and contributes to overall improvements in maternal and child health outcomes.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations for improving access to maternal health:

1. Strengthening the DHFF system: Address the lack of computers and poor internet connectivity, as well as limited knowledge of the staff about the system. This can be done through providing necessary infrastructure and training programs for the staff.

2. Enhancing the supply chain management: Address the insufficient supply of medical equipment and unstable stock of the Medical Stores Department. This can be achieved by improving coordination between health facilities and the Medical Stores Department, as well as exploring alternative suppliers to ensure a steady supply of essential items.

3. Increasing health workforce: Address the inadequate health workforce by recruiting and training more healthcare professionals, particularly in rural areas where access to maternal health services may be limited.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the number of facility deliveries, availability of essential drugs and medical equipment, and quality of care provided.

2. Collect baseline data: Gather data on the selected indicators before implementing the recommendations. This could involve reviewing existing records, conducting surveys, and interviewing key stakeholders.

3. Implement the recommendations: Put the proposed recommendations into action, such as providing computers and internet connectivity, improving supply chain management, and increasing the health workforce.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This could involve regular reporting from health facilities, surveys, and interviews.

5. Analyze the data: Compare the data collected after implementing the recommendations with the baseline data to assess the impact. Use statistical analysis to determine if there are significant improvements in access to maternal health.

6. Evaluate the results: Assess the findings to determine the effectiveness of the recommendations in improving access to maternal health. Identify any challenges or areas for further improvement.

7. Adjust and refine: Based on the evaluation results, make any necessary adjustments to the recommendations and refine the methodology for future simulations.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions on how to further enhance maternal health services in the Pangani district of Tanzania.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.2147/IJWH.S333900

Research Areas:

Community Interventions, Disparities, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants

Study Countries:

Tanzania

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female