Browsing by Author "Mahonge,Christopher"

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Leveraging governance strategies adopted by health facility governing committees in Response to covid-19 outbreak at the local level in Tanzania: a qualitative study
(PLOS, 2022) Kesale,Anosisye Mwandulusya; Mwkasangula,Eliza; Muhanga,Mikidadi; Mahonge,Christopher
The governance of epidemics is very critical for curbing and responding to several infectious epidemics. This study was conducted to explore the experience of the Health Facility Gov- erning Committees (HFGCs) on the governance strategies they adopted to levarage the COVID 19 epidemic in their primary health facilities in Tanzania. An exploratory qualitative design was employed to study the governance strategies adopted by HFGCs during the COVID19. In this study, fourteen (14) HFGC chairpersons and ninety one (91) HFGC mem- bers with experience regulating primary health centers during a COVID 19 pandemic were involved. The study included four (4) governance response metrics that were discovered to be commonly used by HFGCs. These included coordinating responders, providing health information, explaining health hazards, and conducting out health interventions. Despite variations in implementation strategies, only two (2) governance response measures, coor- dinating responders and implementing, were found to be consistently applied by the majority of HFGCs. The nature of the governance path chosen by the Tanzanian government has been found to have influenced the slow reaction of primary health care governance actors such as HFGCs. Despite being empowered by Direct Health Facility Financing, COVID 19 presented challenges to several HFGCs. Though observed to be autonomous and expected to make judgments based on their circumstances, higher-level governance actors’ opinions and actions on epidemics influenced the practices of local-level governance actors, includ- ing HFGCs. Indeed, for the HFGCs’ potential to be realized, they must be empowered in ways other than fiscal and political decentralization. Other aspects of empowering gover- nance actors, such as capacity building and education level, should be considered in order for them to completely realize their potential.
The functionality variation among health facility governing committees under direct health facility financing in Tanzania
(PLOS, 2022) Kesale,Anosisye Mwandulusya; Mahonge,Christopher; Muhanga,Mikidadi
Decentralization reforms through Direct Health Facilities Financing (DHFF) have empow- ered Health Facility Governing Committees (HFGCs) to participate in different governance aspects to improve service delivery at the facility level. However, there is little research on how empowered HFGCs perform in the context of the DHFF. The purpose of this study was to evaluate the functionality of HFGCs under DHFF in Tanzanian primary health care facili- ties that had variation of performance in 2018. To collect both qualitative and quantitative data, the study used a cross-section design. The study had a sample size of 280 respon- dents, who were chosen using a multistage cluster sampling technique from 32 primary health care facilities that were practicing DHFF. Data was collected via a closed-ended structured questionnaire, in-depth interviews with chairpersons of HFGCs, and Focus Group Discussions. To examine the functionality of HFGCs, researchers used descriptive and theme analysis. In the 2018-star rating assessment, the study discovered that HFGCs functioned well in both high and low-performing health facilities. When HFGCs from high- performing health facilities were compared to HFGCs from low-performing health facilities, it was discovered that HFGCs from the high-performing health facilities had comparatively high functionality. The functionality of HFGCs in Tanzania has thus been impacted by the DHFF context.
The quest for accountability of health facility governing committees implementing direct health facility financing in Tanzania: a supply-side experience
(PLOS, 2022) Kesale,Anosisye Mwandulusya; Mahonge,Christopher; Muhanga,Mikidadi
User committees, such as Health Facility Governing Committees, are popular platforms for representing communities and civil society in holding service providers accountable. Fiscal decentralization via various arrangements such as Direct Health Facility Financing is thought to strengthen Health Facility Governing Committees in improving accountability in carrying out the devolved tasks and mandates. The purpose of this study was to analyze the status of accountability of Health Facility Governing Committees in Tanzania under the Direct Health Facility Financing setting as perceived by the supply side. In 32 different health institutions, a cross-sectional design was used to collect both qualitative and quantitative data at one point in time. Data was collected through a closed-ended questionnaire, an in- depth interview, and a Focus Group Discussion. Descriptive statistics, multiple logistic regression, and theme analysis were used to analyze the data. According to the findings, Health Facility Governing Committees’ accountability is 78%. Committees have a high level of accountability in terms of encouraging the community to join community health funds (91.71%), receiving medicines and medical commodities (88.57%), and providing timely health services (84.29%). The health facility governance committee’s responsibility was shown to be substantially connected with the health planning component (p = 0.0048) and the financial management aspect (p = 0.0045). This study found that the fiscal decentraliza- tion setting permits Committees to be accountable for carrying out their obligations, resulting in improved health service delivery in developing nations.