University of Dar es Salaam School of Health Sciences

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Browsing University of Dar es Salaam School of Health Sciences by Author "Bos, Frieda"

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    Factors influencing comprehensive health planning process and implementation of health services in Muheza District
    (University of Dar es Salaam, 2003) Bos, Frieda
    This dissertation reports on a cross-sectional study, conducted for five weeks in May and June 2003. The objective was to assess how selected factors influence comprehensive planning and implementation of health services in Muheza District. Special emphasis was put on the importance of the Health Basket Fund (HBF), in the context of planning, budgeting and implementation of health interventions. A total of 25 respondents were interviewed: Council Health Management Team members, District Council personnel, development partners and health workers. A number of data collection tools were used to collect qualitative and quantitative data: document review, in-depth interviews, observation and attendance to a three-day annual regional Primary Health Care meeting. The Comprehensive Council Health Plans (CCHPs) were found to be gradually improving in the three years. However, some remaining quality issues were related to analysis of health problems, setting of objectives, linking priority problems with interventions and output; setting of output and outcome indicators to monitor implementation and lastly, budgeting. Quarterly reporting was improving, but done irregularly. Problems identified were related to presence of vague descriptions of activities, inconsistencies between the technical and financial reports; booking of expenditures in the wrong cost centres and calculation errors. In a number of occasions the quality of the CCHPs and reports was linked to HBF guidelines and format shortcomings. The health department was supported by quite a number of development partners, who together brought in a substantial amount of funds. Their contribution included capacity building (computer courses, the introduction of computerized Health Management Information System, the development of planning software, planning of training activities and support towards planning sessions and plan editing). Other Charges (OC) income for health in Muheza District was increasing. Of all the sources, the HBF, Block Grant (OC) and funds from the Muheza District Development Programme were regarded as most reliable in terms of either accessibility or control by the health department. The HBF was the main financial source for: administration, vehicle maintenance, purchase of medical equipment, fuel/distribution, minor rehabilitation, outreach and mobile services, supervision and training. The main problem identified in the HBF was that of repeated disbursement delays, which seriously hampered implementing HBF funded activities as planned. It was sometimes difficult to establish how much had been implemented of what was planned, due to lack of numbering and annual reporting. The implementation of health services, especially non-routine activities, was delayed due to: disbursement delays (HBF), accessibility of funds; low capacity to absorb funds; wrong budgeting, delay in getting community contributions and competing activities (pilot projects, emerging issues, unplanned meetings etc.). With regards to reproductive health the allocation of resources remained relatively low during the three years. The monitoring process was weak and use of health data for monitoring and evaluation were under utilised.