Status of countrywide laboratory services quality and capacity in primary healthcare facilities in Tanzania: Findings from Star Rating Assessment.

Accurate disease diagnosis relies on a well-organized and reliable laboratory system. This study assesses the quality of laboratory services in Tanzania based on the nationwide Star Rating Assessment (SRA) of Primary Healthcare (PHC) facilities conducted in 2017/18. This cross-sectional study utilized secondary data from all the country's PHC facilities stored in the SRA database. Laboratory service quality was assessed by aggregating scores as percentages of the maximum achievable score across various indicators: dedicated laboratory department/room, adequate equipment, staffing levels, adherence to testing protocols, establishment of turnaround times, internal and external quality controls, and safety and supplies management. Scores equal to or exceeding 80% were deemed compliant. Multiple linear regression was used to determine the influence of facility characteristics (level, ownership, location, staffing) on quality scores, with statistical significance set at p < 0.05. The study included 6,663 PHC facilities (85.9% dispensaries, 11% health centers, 3.2% hospital-level-1), with the majority being public (82.3% vs. 17.7%) and located in rural areas (77.1% vs. 22.9%). On average, facilities scored 30.8% (SD = 35.7), and only 26.6% met staffing requirements. Compliance with quality standards was higher in private (63% vs. 19%, p<0.001) and urban facilities (62% vs. 16%, p<0.001). More than half of the facilities did not meet either of the eight quality indicators. Quality was positively linked to staffing compliance (Beta = 5.770) but negatively impacted by dispensaries (Beta = -6.342), rural locations (Beta = -0.945), and public ownership (Beta = -1.459). A score of 30% falls significantly short of the national target of 80%. Improving laboratory staffing levels at PHC facilities could improve the quality of laboratory services, especially in public facilities that are based in rural areas. There is a need to further strengthen laboratory services in PHC facilities to ensure the quality of laboratory services and clients' satisfaction.

Clients satisfaction at primary healthcare facilities and its association with implementation of client service charter in Tanzania.

BACKGROUND: Client service charter (CSC) provides information about what people can expect in a facility's services; what is expected of clients and service providers. Tanzania implemented Star Rating Assessment (SRA) of primary health care (PHC) facilities in 2015/16 and 2017/18 using SRA tools with 12 service areas. This paper assesses the status of service area 7, namely client focus that checked if client was satisfied with services provided and implementation of CSC through three indicators-if: CSC was displayed; CSC was monitored; client feedback mechanism and complaints handling was in place. METHODS: We extracted and performed a cross-sectional secondary data analysis of data related to clients' focus that are found in national SRA database of 2017/2018 using STATA version 15. Client satisfaction was regarded as dependent variable while facility characteristics plus three indicators of CSC as independent variables. Multivariate logistic regression with p-value of 5% and 95% confidence interval (CI) were applied. RESULTS: A total of 4,523 facilities met our inclusion criteria; 3,987 (88.2%) were dispensaries, 408 (9.0%) health centres and 128 (2.8%) hospitals. CSC was displayed in 69.1% facilities, monitored in 32.4% facilities, and 32.5% of the facilities had mechanisms for clients' feedback and handling complaints. The overall prevalence of clients' satisfaction was 72.8%. Clients' satisfaction was strongly associated with all implementation indicators of CSC. Clients from urban-based facilities had 21% increased satisfaction compared rural-based facilities (AOR 1.21; 95%CI: 1.00-1.46); and clients from hospitals had 39% increased satisfaction compared to dispensaries (AOR 1.39; 95%CI: 1.10-1.77). CONCLUSION: The implementation of CSC is low among Tanzanian PHC facilities. Clients are more satisfied if received healthcare services from facilities that display the charter, monitor its implementation, have mechanisms to obtain clients feedback and handle complaints. Clients' satisfaction at PHC could be improved through adoption and implementation of CSC.

Social accountability in primary health care facilities in Tanzania: Results from Star Rating Assessment.

BACKGROUND: Star Rating Assessment (SRA) was initiated in 2015 in Tanzania aiming at improving the quality of services provided in Primary Healthcare (PHC) facilities. Social accountability (SA) is among the 12 assessment areas of SRA tools. We aimed to assess the SA performance and its predictors among PHC facilities in Tanzania based on findings of a nationwide reassessment conducted in 2017/18. METHODS: We used the SRA database with results of 2017/2018 to perform a cross-sectional secondary data analysis on SA dataset. We used proportions to determine the performance of the following five SA indicators: functional committees/boards, display of information on available resources, addressing local concerns, health workers' engagement with local community, and involvement of community in facility planning process. A facility needed four indicators to be qualified as socially accountable. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine facilities characteristics associated with SA, namely location (urban or rural), ownership (private or public) and level of service (hospital, health centre or dispensary). RESULTS: We included a total of 3,032 PHC facilities of which majority were dispensaries (86.4%), public-owned (76.3%), and located in rural areas (76.0%). On average, 30.4% of the facilities were socially accountable; 72.0% engaged with local communities; and 65.5% involved communities in facility planning process. Nevertheless, as few as 22.5% had functional Health Committees/Boards. A facility was likely to be socially-accountable if public-owned [AOR 5.92; CI: 4.48-7.82, p = 0.001], based in urban areas [AOR 1.25; 95% CI: 1.01-1.53, p = 0.038] or operates at a level higher than Dispensaries (Health centre or Hospital levels). CONCLUSION: Most of the Tanzanian PHC facilities are not socially accountable and therefore much effort in improving the situation should be done. The efforts should target the lower-level facilities, private-owned and rural-based PHC facilities. Regional authorities must capacitate facility committees/boards and ensure guidelines on SA are followed.