Learning from Health Care Workers' Opinions for Improving Quality of Neonatal Health Care in Kilimanjaro Region; Northeast Tanzania

Background: There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania. Aim: The aim of this study is to assess the performance of health workers for neonatal health-care. Materials and Methods: Settings - Peripheral health facilities (regional referral; district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region; Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26 th November; 2010 to 25 th April; 2011. We analyzed our quantitative data by using STATA v10 (StataCorp; TX; USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables. Results: Birth asphyxia was the most recalled health problem requiring critical care; reported by 27.5 (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4 (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5 (67/140). In the periphery (40); first comment was on management and follow-up of neonatal cases 47.5 (19/40); second on a need of skills 45 (18/40) and third on timely referrals 7.5 (18/40). Shortage of proper equipment was reported at 26.4 (37/140); shortage of staff was reported at 12.0 (17/140); lack of organization of care 11.4 (16/140) and poor hygiene at 2.9 (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95 confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson ?2 [2] = 53.8; P 0.001). Conclusion: Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation

Status and Visions for the School Health Service as Reported by Local Health Care Workers in Northern Tanzania

Objective: The World Health Organization's (WHO) Global School Health Initiative provides a strategy to utilize schools to promote health and reduce the burden of diseases worldwide. The aim of this study was to investigate local school health work in Tanzania in relation to existing national guidelines and the WHO initiative. Methods: We intervie- wed 30 health care workers employed at 15 health institutions throughout Arusha and Kilimanjaro regions. Results: The results indicate a wide gap between the national and international guidelines for school health programs and the health workers' current practices. We found the main obstacles to providing adequate health care to be related to the burden of poverty that influences all levels of school health services; lack of clarity regarding the current official guidelines for school health services; and lack of appropriate offers for continuing education in the area of school health services. Conclusion: In order to successfully establish an integrated school health service; the working relationship between schools; health centres and the community clearly needs improvement

Improving motivation among primary health care workers in Tanzania: a health worker perspective

In Tanzania access to urban and rural primary health care is relatively widespread; yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality. The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region; Tanzania; in terms of their motivation to work; satisfaction and frustration; and to identify areas for sustainable improvement to the services they provide. The primary issues arising pertain to complexities of multitasking in an environment of staff shortages; a desire for more structured and supportive supervision from managers; and improved transparency in career development opportunities. Further; suggestions were made for inter-facility exchanges; particularly on commonly referred cases. The discussion highlights the context of some of the problems identified in the results and suggests that some of the preferences presented by the health workers be discussed at policy level with a view to adding value to most services with minimum additional resources