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

Abstract

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.

Role of health facility governing committees in strengthening social accountability to improve the health system in Tanzania: protocol for a participatory action research study

“…Recent studies in Tanzania have explored the functionality of the HFGCs, recognising the poor to average performance, that they are largely inactive and rarely provide an oversight function, and that their involvement in providing governance is limited 12 14 18–20. The key bottlenecks often include limited skills and capacity, limited awareness of the community members regarding the roles and responsibilities of the HFGCs, inadequate interest in and support among key health workers or managers, lack of interest from communities, inadequate access to financial resources and a lack of financial incentives for the committee members and thus difficulty in discharging and sustaining voluntary membership over time 12 18 21. Health facility planning and budgeting is consequently ad hoc and not evidence based.…”

“…Explorative studies from different contexts have suggested that training11 18 19 is a way forward to empower HFGCs, but they have also highlighted the importance of paying attention to the socioeconomic and cultural contexts in which they operate, including power relationships between healthcare providers and the HFGCs, and political capabilities and how HFGCs perceive their role 8 19 20. There is, however, a scarcity of participatory (action) research on how to better strengthen and implement social accountability mechanisms, such as the HFGCs, and their relationships with healthcare providers and the community they serve 16 18 22…”