Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania.

BACKGROUND: Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania. METHODS: This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation. RESULTS: Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders' engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor. CONCLUSION: Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.

Fluoride contamination of selected food crops, domestic water, and milk consumed by communities around mount Meru in Northern Tanzania.

This study assessed fluoride levels in domestic water, commonly consumed food crops, cow's, and human milk. Samples of vegetables were collected from farmer's home gardens, green banana from local markets, maize flour, and domestic water from households, while cow's and human (breast) milk were obtained from cows and lactating mothers. Fluoride levels were determined by using a fluoride ion-selective electrode. Fluoride levels were 0.03 ± 0.02 mg/kg in maize, In leafy vegetables the highest levels were found in nightshade 0.081 ± 0.008 mg/kg, while for banana varieties the highest levels were found in in East African highland 0.025 ± 0.004 mg/kg. Levels in cows and human breast milk were 0.34 ± 0.2 mg/L and 0.077 ± 0.06 mg/L, respectively. Levels in domestic and public tap water were 4.57 ± 0.4 mg/L and 4.74 ± 0.8 mg/L, respectively. Study provided useful knowledge of fluoride levels in several crops, milk, and domestic water.

Seasonal variations in the availability of fodder resources and practices of dairy cattle feeding among the smallholder farmers in Western Usambara Highlands, Tanzania.

The aim of this study was to assess the seasonal effects on quantity and quality of fodder resources and associated utilization practices among smallholder dairy farmers in Western Usambara Highlands (WUHs) in Tanzania. The WUHs are among the major milk producing areas under smallholder dairy farming systems (SDFS) in Tanzania. Dry season fodder scarcity is a widespread problem affecting the East African SDFS and has been shown to contribute to over 40% reduction in milk yield. There is limited information with regard to seasonal fodder fluctuation and its effects on productivity of dairy cows in different landscape levels of Tanzania. Field and household surveys were conducted in 150 dairy cattle farming households from five villages in three wards located in WUHs. Survey data were analyzed using IBM SPSS version 21. In addition, remote sensing techniques were employed on gap-filled and smoothed Landsat data to generate land cover maps and bimonthly normalized difference vegetation index-time series for the 2009-2016. SDFS landscape was highly heterogeneous typified by crops, bushes, and forests. On average, the household landholding was 1.3 ha, while herd size was three cattle. About 87% of household land was devoted to crop growing with limited pasture along the farm margins and contour strips. Fodder scarcity was the major challenge during the dry season (July to October) as indicated by 87% of the respondents. On-farm fodder resources contributed most of the cattle diet (73%) while rangeland, forest, and purchased feed provided small amount. Natural pasture and napier grass (Pennisetum purpureum) were the most important feeds in wet season while maize stover was most significant during the dry season. Maize stover was profusely stored for dry season feeding and neither silage nor hay making was practiced. The nutritional values of the fibrous feeds declined during the dry season, whereby the metabolizable energy and crude protein contents were 6.0 MJ/kg and 10.1% dry matter, respectively, during wet season compared to 4.8 MJ/kg and 7.8% dry matter, respectively, during the dry season. Consequently, milk yield drops from 5.6 l per cow per day in the wet season to 3.0 l in the dry season. It is concluded that dry season fodder scarcity is a major problem in the WUHs and it hinders sustainable dairy production. It is therefore suggested that increase in fodder production as well as adoption of fodder conservation and feeding technologies are inevitable if sustainable dairy production is to be met in the Western Usambara Highlands and elsewhere with similar environments.