Browsing by Author "Kapologwe, Ntuli Angyelile"

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    Biolarviciding implementation in southern Tanzania: Scalability opportunities and challenges
    (PLOS ONE, 2022) Matindo, Athuman Yusuph; Meshi, Eugene Benjamin; Kapologwe, Ntuli Angyelile; Kengia, James Tumaini; Kajange, Stella; Chaki, Prosper; Munisi, David Zadock
    The resistance to insecticides among malaria vectors poses a global challenge in the efforts towards malaria elimination. This calls for an addition of larval control methods such as biolarviciding. However, the implementation of biolarviciding in Tanzania has been very low. Therefore, this study explored factors affecting the implementation of biolarviciding in the councils of Southern Tanzania. A mixed method descriptive qualitative, cross-sectional study design was used to collect data from 32 community leaders through key informant interviews and 12 Vectors Control Coordinators through in-depth interviews and questionnaire interviews and document review of implementation reports in 12 councils. Data were analysed using ATLAS version 8, where content analysis was performed and SPSS for the quantitative data. The study found low implementation of biolarviciding intervention in 9 out of 12 (75%) surveyed councils. All Vector Control Coordinators reported a shortage of at least one type of resources: funds, trained personnel, transport, supply of biolarvicide, and equipment; low community involvement (50%) and low level of community participation 83.3% (10/12). This study highlights resource inadequacy and low community participation as main barriers to the implementation of biolarviciding. Availing adequate resources and strengthening community participation through involvement in all stages of implementation is crucial for successful and sustainable implementation.
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    Implementation of direct health facility financing in public primary health facilities in Tanzania: effects on health system performance.
    (The University of Dodoma, 2020) Kapologwe, Ntuli Angyelile
    Tanzania, like many countries globally, has continuously been implementing health sector reforms with the intent of ensuring affordable health services to the population, in alignment with the shift towards Universal Health Coverage as well as improving the quality of health services, among these reforms has been the introduction of Direct Health Facility Financing (DHFF), which has limited evidence on its implementation and outcomes with respect to its intended goals. This study aimed to assess the implementation of DHFF in the Public Primary Health Facilities (PPHFs) as well as its effects on health system performance in Tanzania. This study was conducted from January 2018 to September 2019 utilized a before and after non-controlled study design with a process evaluation embedded at midline. Both quantitative and qualitative methods were used for data collection. A structured questionnaire was used to obtain the quantitative data from exiting patients, and health care workers in 42 PPHFs. Qualitative data was collected using an interview guide through 14 in depth interviews and seven focus group discussions to health managers at council level from 14 councils in seven regions. Quantitaive data analysis was done using SPSS™ version 25 while for qualitative NVIVO QSR™ version 12 was used. A total of 844 exiting patients were studied on seven domains of Health System Responsiveness (HSR) at baseline and endline. All but one domain (i.e. communication) of HSR were found to have positive significant difference between baseline and endline. Overall HSR improved significantly from 62.84% at baseline to 71.20% at end line (p<0.0001). In a multivariable logistic regression model, patients who were studied at the end line were four times more likely to have experienced positive responsiveness as compared to those at the baseline. Forty-two (42) PPHFs were studied based on structural quality of maternal health services (MHS). The majority (71%) of the facilities were within 10 kilometers of participants’ residences. Of note, the majority (88.9%) of dispensaries and 60% of health centers were below the required staffing level. There were significant differences on structural quality of MHS between baseline and endline (2.38% and 30.9% respectively). With respect to maternal health services utilization, 42 facilities were studied on nine maternal health service consumption indicators before and after the introduction of the DHFF initiative. There were significant differences in all indicators after DHFF introduction except those for intermittent presumptive treatment for malaria second dose, use of modern family planning methods, and mebendazole use. Of 238 health care providers who participated in the Fidelity of Implementation (FoI) component of the study, the majority (76%) had adequate knowledge on the DHFF implementation issues while only 28% had high Fidelity of Implementation (FoI scores. For health service providers working in the rural settings, training and knowledge on the DHFF and Facility Financial Accounting and Reporting System (FFARS) were significantly associated with high FoI. In the multiple logistic regression model, both positive HSR (AOR 3.4 [95%CI: 1.637, 7.064]), and high maternal health service utilization (AOR 40.971[95%CI: 4.065, 412.927]) were strongly associated with high structural quality of MHS. Health service providers indicated an improvement in both governance and accountability, especially in the areas of planning and budgeting, financial management and transparency, with the implementation of the DHFF. However, the majority of health care providers admitted to have not received adequate supportive supervision and mentorship. The providers also felt that this initiative added an additional burden to their routine work. In general, the DHFF have affected the health system, specifically on health system performance in Tanzania. FoI was low despite training being offered to health care providers, which indicates a need for more investment on this aspect in order to have a resilient health system. Improved governance and accountability have been positive outcome on DHFF implementation, which indicate the merits in ongoing efforts to invest on governance and accountability at PPHFs.
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    The role of community participation in planning and executing malaria interventions: experience from implementation of Biolarviciding for malaria vector control in Southern Tanzania
    (Hindawi, 2022) Matindo, Athuman Y.; Kalolo, Albino; Kengia, James Tumaini; Kapologwe, Ntuli Angyelile; Munisi, David Zadock
    Malaria remains a disease of great public health importance in 85 countries globally. Developing countries face resource constraints in implementing public health interventions aiming at controlling malaria. Promoting community participation may contribute to rational and effective use of resources and therefore facilitating achievement of intervention goals in a cost-effective manner while fostering sustainability. However, this can be possible if the community is engaged at all stages of the intervention, from designing, implementation, monitoring, and evaluation of results. This study aimed at understanding community participation in the implementation of a biolarviciding intervention for malaria vectors control in Southern Tanzania. The current study adopted explanatory mixed method study design in collecting data. Quantitative data were collected from 400 community members and 12 vector control coordinators using structured questionnaire while qualitative data was collected through key informant interviews to 32 participants and in-depth interviews to 5 vector control coordinators who were purposively selected from the 12 councils. Quantitative data analysis involved descriptive and inferential statistics. Thematic analysis was used to analyse qualitative data. Of 400 community members, only 90 (22.5%) participated in biolarviciding implementation. Predictors of community participation were willingness to participate (AOR = 3:15, 95%CI = 1:14 − 8:71, P value = 0.027) and community involvement (AOR = 6:07, 95% CI = 2:69 − 13:71, P value < 0.001). The study revealed that the main barriers to community participation were lack of effective involvement and lack of incentive to community volunteers while high willingness to participate was a facilitating factor for community participation. The study revealed low community participation in biolarviciding implementation in Southern Tanzania with willingness to participate and community involvement being the main predictors for community participation while lack of incentive to community volunteers was one major barrier to community participation. This explains the persistence of an unresolved challenge of community participation in malaria interventions. Therefore, more efforts are needed to improve the participation of community members in Malaria interventions through advocacy, awareness creation of respective roles, and responsibilities of the community members and fostering community ownership. Additionally, councils need to design customized motivation package for the community members.