Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements

Sirili, Nathanael; Kiwara, Angwara; Frumence, Gasto; Goicolea, Isabel; Hurtig, Anna-Karin

doi:10.1186/s12960-017-0202-7

Cited by 34 publications

(53 citation statements)

References 17 publications

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“…Compounding the challenge of EU bed capacity is the shortage of ICU bed in all the regional hospitals; two regional hospitals had no ICU capacity at all. In all EUs we found a low staffing level, similar to that observed in previous studies of EU staffing in Tanzania [9]. A combination of limited infrastructure, low staffing and shortage of supplies might further explain the observed low capture rate of injury variables.…”

Section: Discussionsupporting

confidence: 87%

“…In Tanzania, like most LMICs, there is a substantial shortage of both human and infrastructural resource for optimal provision of health services [8,9]. The public health system, which attends to majority of patients, is organised in a pyramidal structure with most emergency care for trauma occurring at the lower tier of the system -most of which have no dedicated emergency care providers [8,10].…”

Section: Introductionmentioning

confidence: 99%

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Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

et al. 2020

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Background: In Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set. Methods: This was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables. Results: During the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts. Conclusions: In the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

et al. 2020

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“…Kilwa is one of the six districts comprising Lindi region that is found in the southern zone of Tanzania. is is one of the zones that have severe health workforce shortage [23].…”

Section: Study Settingmentioning

confidence: 99%

“…e shortage of health workforce in rural areas is observed despite the efforts undertaken by the government of Tanzania in the provision of both financial and nonfinancial incentives [19]. e nonfinancial incentive strategies have included; opportunities for further education, proactive staff recruitment, bonding schemes, contracting arrangements, and provision of accommodation to the health workers [8,19,[21][22][23]. While the financial incentive strategies have faced budgetary difficulties most of the nonfinancial incentives have had budgetary implications thus rendering its implementation difficult [24].…”

Section: Introductionmentioning

confidence: 99%

Understanding the Rural–Rural Migration of Health Workers in Two Selected Districts of Tanzania

Sirili

Simba

2020

Advances in Public Health

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Globally, rural–urban migration has been the focus in addressing the question of availability of health workers in rural areas. Often, the rural–rural migration of health workers, another important dimension is neglected. This study aimed to analyze the magnitude and the underlying factors for rural–rural migration of health workers in two rural districts of Tanzania. An exploratory comparative cross-sectional study adopting both quantitative and qualitative approaches was carried out in two districts of Kilwa in Lindi region, southern Tanzania, and Rombo in Kilimanjaro region, northern Tanzania. In a quantitative approach, 174 health workers (both clinicians and nonclinicians) filled in a self-administered questionnaire between August 2015 and September 2016. For the qualitative sub-study, 14 key informants that included health facilities in-charges and district health managers from the two districts were interviewed. In addition, three focus group discussions were conducted with members of the health facilities committee, in the two districts. Over 40% of health workers migrated from one workstation to another between 2011 and 2015. Close to 70% of the migrated health workers, migrated within the same districts. The proportion of health workers migrated was higher in Kilwa compared to Rombo. However, the difference was not statistically significant. The major underlying factors for migration in both districts were: Caring for the family and Unfavorable working and living conditions. In Kilwa, unlike Rombo, rejection by the community, superstitious beliefs, and lack of social services, were the other major factors underlying migration of the health workers. While addressing rural–urban migration, attention should be paid also to the rural–rural migration of health workers. Lastly, addressing the migration of health workers is a multi-dimensional issue that needs the engagement of all stakeholders within and beyond the health sector.

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“…28 Despite these efforts, the country still suffers a 56% shortage of skilled staff that could provide C-Section services. 29 In 2013, low densities of doctors, AMOs and nurses were reported as 0.260, 0.399 and 3,231 per 10,000 (ten thousand) population respectively. 30 Of the 1,135 medical doctors available, 69% work in urban centers leaving only 31% to serve 75% of the rural population.…”

Section: Essential Supplies Including Blood and Medicinesmentioning

confidence: 99%

Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania

Matinhure¹,

Chimbari²,

Mapunda³

2018

Ghana Medical Journal

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Objective: Tanzania has a high maternal mortality ratio of 556 per 100,000 live births. Timely caesarean sections avert mortality due to life threatening conditions like obstructed labour. This study assessed capacity of selected health facilities to provide caesarean sections in terms of infrastructure, equipment, essential supplies and skill mix. Methods: A cross-sectional mixed methods design was used to include systematic observations using highly structured checklists to determine the adequacy of infrastructure, functional status of equipment, availability of supplies and skill mix. An interview guide and a key-informant interview guide were used to collect data from assistant medical officers and key informants respectively. Descriptive data analysis was conducted using IBM SPSS software package. Results: Deficit for doctors ranged between 3 (37.5%) and 5 (62.5%) per each district hospital. Two out of 3 health centres did not have doctors. Deficit for assistant medical doctors ranged between 10 (62.5%) and 11 (68.8%) per each district hospital. In terms of absolute numbers, assistant medical doctors were more than doctors. Not all facilities had all the equipment, infrastructure or supplies. Challenges cited by most assistant medical officers were; shortage of theatre-trained nurses (91%; n=21), theatres not functioning (61%; n=14), inadequate blood supply (87%; n=20) and inadequate equipment (96%; n=22). Conclusion: Capacity of health facilities to provide caesarean sections was found to be sub-optimal due to health workforce shortages, inadequate infrastructure, equipment and supplies, thus increasing the risk of maternal deaths. These findings are useful in informing strategies to reduce maternal mortality.

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Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements

Cited by 34 publications

References 17 publications

Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

Understanding the Rural–Rural Migration of Health Workers in Two Selected Districts of Tanzania

Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania

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