RESUMO
Immunization coverage remains a challenge in many developing countries Tanzania being no exception. The current increase in technology adoption in the immunisation supply chain promises the attainment of universal health coverage and Sustainable Development Goals (SDGs) on immunisation. This study evaluates the effectiveness of technology integration in Vaccine and Immunization Health Supply Chain Management (VIHSCM) in Tanzania. This study adopted an exploratory descriptive cross-sectional design. The study collected data using structured questionnaires from health facilities that adopted VIHSCM technologies in Arusha, Mwanza, Morogoro and Mbeya regions, Tanzania. Data were analysed using descriptive statistics and cross-tabulations with the aid of the Statistical Package of Social Sciences 23rd Edition (SPSS). The study included 37 health facilities in Tanzania, mainly district hospitals (59.5%). Respondents were mostly female (70.3%), averaging 45 years old, with 1-5 years of immunization experience. While all facilities had refrigerators, digital reporting tool usage was low, with many relying on paper forms. District hospitals and health centres had higher digital tool adoption rates compared to dispensaries. Despite the underutilization of systems like ILS, TImR, and GoTHOMIS, digital tools were deemed crucial for vaccine supply management. While District Hospitals report high relevance of digital tools, Health Centres and Dispensaries show moderate relevance. Challenges include incomplete technology adoption, inadequate infrastructure, and variable perceptions of technology effectiveness. Digital technologies significantly improve vaccine and immunization supply chain management, particularly in larger facilities. Technologies like the Tanzania Immunization Registry (TImR) and Integrated Logistics Systems (ILS) enhance data accuracy and efficiency. Addressing facility-specific challenges and increasing investment in digital tools are crucial for optimizing vaccine supply chains and achieving immunization targets in Tanzania. Future research should involve larger samples to generalize findings and further explore technology impacts on VIHSCM.
RESUMO
BACKGROUND: The Tanzania healthcare system is beset by prolonged waiting time in its hospitals particularly in the outpatient departments (OPD). Previous studies conducted at Kilimanjaro Christian Medical Centre (KCMC) revealed that patients typically waited an average of six hours before receiving the services at the OPD making KCMC have the longest waiting time of all the Zonal and National Referral Hospitals. KCMC implemented various interventions from 2016 to 2021 to reduce the waiting time. This study evaluates the outcome of the interventions on waiting time at the OPD. METHODS: This is an analytical cross-sectional mixed method using an explanatory sequential design. The study enrolled 412 patients who completed a structured questionnaire and in-depth interviews (IDI) were conducted among 24 participants (i.e., 12 healthcare providers and 12 patients) from 3rd to 14th July, 2023. Also, a documentary review was conducted to review benchmarks with regards to waiting time. Quantitative data analysis included descriptive statistics, bivariable and multivariable. All statistical tests were conducted at 5% significance level. Thematic analysis was used to analyse qualitative data. RESULTS: The findings suggest that post-intervention of technical strategies, the overall median OPD waiting time significantly decreased to 3 h 30 min IQR (2.51-4.08), marking a 45% reduction from the previous six-hour wait. Substantial improvements were observed in the waiting time for registration (9 min), payment (10 min), triage (14 min for insured patients), and pharmacy (4 min). Among the implemented strategies, electronic medical records emerged as a significant predictor to reduced waiting time (AOR = 2.08, 95% CI, 1.10-3.94, p-value = 0.025). IDI findings suggested a positive shift in patients' perceptions of OPD waiting time. Problems identified that still need addressing include, ineffective implementation of block appointment and extension of clinic days was linked to issues of ownership, organizational culture, insufficient training, and ineffective follow-up. The shared use of central modern diagnostic equipment between inpatient and outpatient services at the radiology department resulted in delays. CONCLUSION: The established technical strategies have been effective in reducing waiting time, although further action is needed to attain the global standard of 30 min to 2 h OPD waiting time.