Outcome evaluation of technical strategies on reduction of patient waiting time in the outpatient department at Kilimanjaro Christian Medical Centre-Northern Tanzania.

BACKGROUND: The Tanzania healthcare system is beset by prolonged waiting time in its hospitals particularly in the outpatient departments (OPD). Previous studies conducted at Kilimanjaro Christian Medical Centre (KCMC) revealed that patients typically waited an average of six hours before receiving the services at the OPD making KCMC have the longest waiting time of all the Zonal and National Referral Hospitals. KCMC implemented various interventions from 2016 to 2021 to reduce the waiting time. This study evaluates the outcome of the interventions on waiting time at the OPD. METHODS: This is an analytical cross-sectional mixed method using an explanatory sequential design. The study enrolled 412 patients who completed a structured questionnaire and in-depth interviews (IDI) were conducted among 24 participants (i.e., 12 healthcare providers and 12 patients) from 3rd to 14th July, 2023. Also, a documentary review was conducted to review benchmarks with regards to waiting time. Quantitative data analysis included descriptive statistics, bivariable and multivariable. All statistical tests were conducted at 5% significance level. Thematic analysis was used to analyse qualitative data. RESULTS: The findings suggest that post-intervention of technical strategies, the overall median OPD waiting time significantly decreased to 3 h 30 min IQR (2.51-4.08), marking a 45% reduction from the previous six-hour wait. Substantial improvements were observed in the waiting time for registration (9 min), payment (10 min), triage (14 min for insured patients), and pharmacy (4 min). Among the implemented strategies, electronic medical records emerged as a significant predictor to reduced waiting time (AOR = 2.08, 95% CI, 1.10-3.94, p-value = 0.025). IDI findings suggested a positive shift in patients' perceptions of OPD waiting time. Problems identified that still need addressing include, ineffective implementation of block appointment and extension of clinic days was linked to issues of ownership, organizational culture, insufficient training, and ineffective follow-up. The shared use of central modern diagnostic equipment between inpatient and outpatient services at the radiology department resulted in delays. CONCLUSION: The established technical strategies have been effective in reducing waiting time, although further action is needed to attain the global standard of 30 min to 2 h OPD waiting time.

Effectiveness of prime vendor system on availability of medicines and medical supplies in the selected public health facilities in Arusha district council.

INTRODUCTION: The shortage of medicines and medical supplies remains to be a major issue that is facing public health facilities in Tanzania. This situation has been influenced by lack of consistency in the supply chain, increase in healthcare demand, poor regulatory system, insufficient funds, and lack of conducive infrastructure. Formerly, the Government initiatives such as engagement with the Prime Vendor System (PVS) demonstrated great assistance in getting rid of this challenge. Despite the operation of PVS, a recent shortage of medicines and medical supplies has been noticed. OBJECTIVES: This study aimed to assess the effectiveness of PVS on the availability of medicine and medical supplies in the selected public health facilities in Arusha District Council. METHODS: The study used a case study design with mixed research approach. The study involved 77 respondents which included 25 health facility in-charges, 50 patients, 1 District Pharmacist and 1 Prime Vendor. Questionnaires, interviews, and observation methods were used to collect data. Data collected covered a period of 2021-2022. Thematic analysis was used to analyze the qualitative data whereas descriptive analysis was used to analyze the quantitative data with the help of Excel and the Statistical Package for Social Sciences (SPSS) version 28.0. RESULTS: The analysis indicates that PVS is not completely effective in supplying medicines and medical supplies due to its low capacity to conform to the orders placed by the public health facilities, a lack of supply competition, and a failure to adhere to contractual terms. Furthermore, at the time of data collection, the average availability of medicines and medical supplies at the selected public health facilities was 74.8%, while 80% of the selected public health facilities reported having a scarcity of medicines and medical supplies, and 92% of the interviewed patients reported having no full access to medicines. CONCLUSION: Despite the shortcomings associated with the operation of the PVS, the system still seems to be very important for enhancing the availability of medicines and medical supplies once its effectiveness is strengthened. This study recommends a routine monitoring of PVS operations and timely interventions to reinforce an adherence to the contracted terms and improve PVS effectiveness.

The cost of dialysis in low and middle-income countries: a systematic review.

BACKGROUND: The cost of dialysis in low and middle-Income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries. METHODS: PubMed and Embase databases were searched for the year 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported cost of dialysis from low and middle-Income countries. RESULTS: The annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical cost especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers. CONCLUSION: The number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In case of developing countries, expert interviews are often used for estimating missing information.

Cost of dialysis in Tanzania: evidence from the provider's perspective.

BACKGROUND: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. METHODS: Cost calculations are based on the provider perspective and include only the direct cost of dialysis treatment. Cost of drugs and consumables were obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interview with experts at the dialysis unit. RESULTS: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will cause annual costs of 27,440 US$. CONCLUSION: The cost of dialysis is enormous for a least developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards diseases that are curable, have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all effort must be invested to improve technical efficiency by cutting the enormous unit cost.