Masters Dissertations

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Browsing Masters Dissertations by Author "Adam, Nicholas"

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    Assessment of quality services in primary health care facilities in Moshi-Rural District
    (University of Dar es Salaam, 2001) Adam, Nicholas
    A cross sectional study was conducted in Moshi Rural- district from 15th June to 15th July 2001. Eight primary health care facilities were studied including four public, two private and two voluntary health units.The main objective of the study was to assess the quality of services in primary health care facilities, also to find out the perceptions patients had on the quality of services delivered at these units. Service providers were also interviewed about their perceptions on their working environment, as it relates to quality care A total of 147 patients and 43 service providers were interviewed, health facility observations were made and five focus group discussion were also conducted among the patients Study results showed that the commonest perceived determinant of quality in dispensaries was the availability of drugs. Approximately two third; (65.8%) of patients in public units got their prescribed drugs, as compared with 96.6% in private and 92.3% in voluntary health units. Lack of access to drugs and non-availability of diagnostic equipment in government owned facilities were commonest reasons for patients seeking care from alternative health units. This study also showed existence of a gap between what perceptions patients had on the quality of care delivered and their expectations. These gaps were perceived both in structural and process quality, and they ranged from the infrastructures, environmental sanitation, management of patients, to technical competence of service providers. A gap was also found in manpower deployment at all the three types of health units. The deficiencies were found to be 70% in private, 47.7% in public and 60% in private health facilities. Results of the observations made on sanitation showed that 100% of the outpatients department toilets in public facilities were non-functional while the reverse was true in private and voluntary health units. Supervisory visits from the DMO's office were done regularly in public health units only, but this was not case for the private and voluntary units. It is recommended that improvements to be made on drug availability and supply of necessary working gears in public units. To meet the community expectation for quality care it is recommended public health units should have better drug management also be equipped with the basic diagnosis facilities. A review of manpower deployment in public, privates and voluntary units should be also made to identify the deficiencies and take necessary measures to secure that regulations on manpower deployment adhered to.