Implementation of direct health facility financing in the rural District of Kigoma in Western Tanzania.

The adoption of decentralization by devolution in Tanzania has enabled the implementation of a Direct Health Facility Financing (DHFF) program in the facilities. While copious gains have been reported under DHFF, there are also notable failures to improve health service provision. This study aims to explore the experience of implementing the DHFF program in the rural areas of the Kigoma District Council. An exploratory qualitative study was conducted in Primary Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling technique was used to draw 21 key informants including leaders of health facilities and members of the Health Facility Governing Committees (HFGC). Key Informant Interviews (KII) were used to solicit information from the study participants. Content analysis technique was used to analyze data collected from study participants. Our findings present enablers and barriers in the implementation of DHFF. Successful implementation of DHFF was enabled by the availability of formal training and supportive supervision, adherence to DHFF guidelines, availability of planning guidelines at the health facility, functionality of the HFGC, and adherence to the procurement process. A low sense of ownership of the program, delays and insufficient fund disbursement, shortage of health workers, and inadequate knowledge of DHFF program implementation emerged as the barriers that impeded successful program implementation. Evaluating the implementation experience of the DHFF program requires policymakers at the national level to devise a mechanism for the timely disbursement of funds, reinforcing capacity building to increase the autonomy of health facilities in their daily operations. Furthermore, structural and operational barriers warrant further operational and implementation research.

Prevalence and Factors Associated with Stunting among Public Primary School Pupils in Kasulu District, Western Tanzania.

BACKGROUND: Underfeeding of a child in the first 2 years of life results in irreversible growth damage. Globally, stunting has declined from 39.7% in 1990 to 26.7% in 2010 while in Africa has remained at 40% since 1990. However, stunting is little known in primary pupils.This study estimated the prevalence of stunting and contributing factors among public primary school pupils in Kasulu District. METHOD: Cross-sectional study was conducted among public primary pupils. Systematic random sampling was used to select study participants and then stratified to 5-7 and 8-12 years. Socio-economic factors, dietary practices, water, sanitation, and hygiene behaviours; school performance/attendance data were collected using a pretested questionnaire. Measurements were standardised to the World Health Organization HAZ-Scores for both girls and boys. Descriptive statistics, bivariate, and multivariable logistic regression were used to generate results. RESULTS: A total of 400 pupils (100%RR) were recruited into the study, mean age of 7.51 (STD= 1.54) years and a half (50.3%) were boys. The prevalence of stunting was 127 (31.8%) (95% CI: 27.2%-36.6%), with no sex difference (63 (31.7%) - girls vs. 64 (31.8%) - boys; p = 0.969). Household wealth influenced stunting; lowest quintile (AOR= 28; 95% CI: 3.64 - 214.6; p<0.001) 2nd quintile (AOR = 17; 95%CI: 2.20 - 138.5; p<0.01), the 3rd quintile (AOR = 8.0; 95%CI: 0.99 - 64.67; p = 0.051) and 4th quintile (AOR = 4.2; 95%CI: 0.49 - 36.75; p = 0.191) when compared to 5th (highest) wealthquintile. Food insecurity (AOR = 10.6; 95%CI: 4.60 - 24.60; p< 0.001), less protein in meal were the risk for stunting (AOR = 14.6; 95%CI: 4.07 - 52.42; p<0.001). Inappropriate hand wash after toilets both at school, (AOR=3.5; 95%CI:1.62-7.58; p=0.001), and home (AOR = 13.0; 95%CI: 2.73 - 61.76; p = 0.001) were the risk for stunting. Stunted pupils had irregular school attendance (AOR = 9.4;95%CI: 4.42 - 19.93; p<0.001) and poor performance (AOR = 23.6; 95%CI: 10.24 -54.19; p<0.001). Food insecurity influenced poor performance (AOR = 3.9; 95%CI:1.67-8.92; p<0.01) and irregular school attendance (AOR=5.4, p=0.000). CONCLUSION: Stunting among public primary school pupils is very high despite the prevention effort. Low wealth, food insecurity, poor hand hygiene, and lack of protein in a meal significantly influence stunting. Also, it affects the pupils' academic performance and attendance, availability of food in both quantity and quality, community nutrition.