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Tanzania Service Provision Assessment Survey 2014-2015

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Tanzania Service Provision Assessment Survey 2014-2015 TANZANIA TANZANIA Service Provision Assessment Service Provision Assessment Service Provision Assessment Survey 2014-2015 Survey 2014-2015 Tanzania Service Provision Assessment Survey 2014-2015 Ministry of Health and Social Welfare Dar es Salaam Ministry of Health Zanzibar National Bureau of Statistics Dar es Salaam Office of Chief Government Statistician Zanzibar ICF International Rockville, Maryland USA February 2016 This report summarises the findings of the 2014-15 Tanzania Service Provision Assessment Survey (2014-15 TSPA), which was implemented by the National Bureau of Statistics (NBS) in collaboration with the Ministry of Health and Social Welfare; Office of Chief Government Statistician (OCGS), Zanzibar; and Ministry of Health, Zanzibar. ICF International provided technical assistance. The 2014-15 TSPA is part of the worldwide DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. The survey was funded by the United States Agency for International Development (USAID). Additional information about the 2014-15 TSPA may be obtained from the National Bureau of Statistics, General Office, 18 Kivukoni Road, P.O. Box 796, 11992 Dar es Salaam, Tanzania. Telephone: 255-22-212-2722/3; Fax: 255-22-213-0852; Internet: www.nbs.go.tz. Information about The DHS Program can be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850 USA. Telephone: 301-407-6500; Fax: 301-407-6501; E-mail: [email protected]; Internet: http://www.DHSprogram.com. Cover photos: © 2014 Charles Wanga, Jhpiego, used with permission. Recommended citation: Ministry of Health and Social Welfare (MoHSW) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF International 2015. Tanzania Service Provision Assessment Survey (TSPA) 2014-15. Dar es Salaam, Tanzania, and Rockville, Maryland, USA: MoHSW, MoH, NBS, OCGS, and ICF International. CONTENTS TABLES AND FIGURES ........................................................................................................................................ vii FOREWORD ............................................................................................................................................................. xv ACKNOWLEDGMENTS ...................................................................................................................................... xvii ABBREVIATIONS AND ACRONYMS ................................................................................................................. xix MAP OF TANZANIA ............................................................................................................................................ xxii 1 OVERVIEW OF THE HEALTH AND SOCIAL SYSTEM IN TANZANIA .......................................... 1 1.1 Demography and Structures of Health and Social Welfare Services ................................................ 1 1.2 Health Status in Tanzania ................................................................................................................. 1 1.3 Enabling Policies and Strategies to Improve Health Status .............................................................. 1 1.3.1 Tanzania Development Vision 2025 ................................................................................... 2 1.3.2 MKUKUTA and Five Year Development Plan 2011/12–2015/16 ..................................... 2 1.3.3 Big Results Now ................................................................................................................. 3 1.4 Organisation of the Health Care System ........................................................................................... 3 1.4.1 Health and Social Welfare Service Structure (Tanzania Mainland) ................................... 3 1.4.2 Administrative Structure of the Ministry of Health in Zanzibar ......................................... 5 1.4.3 Organisation of the Health Care System in Zanzibar .......................................................... 5 1.4.4 Management of Health and Social Welfare Services in Tanzania Mainland ...................... 7 1.5 Service Delivery of the Health and Social Welfare Sector in Tanzania Mainland ............................ 9 1.5.1 Services in Community ....................................................................................................... 9 1.5.2 Services Provided by Institutions........................................................................................ 9 1.6 Health Care Support Systems in Tanzania Mainland ...................................................................... 11 1.6.1 Human Resources for Health ............................................................................................ 11 1.6.2 Essential Medicines and Health Products ......................................................................... 12 1.6.3 Capital Investment ............................................................................................................ 13 1.6.4 Monitoring and Evaluation ............................................................................................... 13 1.6.5 Health Financing ............................................................................................................... 13 2 METHODOLOGY ...................................................................................................................................... 15 2.1 Overview ......................................................................................................................................... 15 2.2 Institutional Framework and Objectives of the 2014-15 TSPA ...................................................... 15 2.2.1 Institutional Framework .................................................................................................... 15 2.2.2 Objectives of the 2014-15 TSPA ...................................................................................... 15 2.3 Data Collection Methods ................................................................................................................ 16 2.4 Sampling ......................................................................................................................................... 17 2.4.1 Sample of Health Facilities ............................................................................................... 17 2.4.2 Sample of Health Service Providers ................................................................................. 18 2.4.3 Sample for Observations and Exit Interviews ................................................................... 19 2.5 Implementation ............................................................................................................................... 19 2.5.1 Questionnaire Adaptation ................................................................................................. 19 2.5.2 Pre-test .............................................................................................................................. 20 2.5.3 Main Training ................................................................................................................... 20 2.5.4 Data Collection ................................................................................................................. 21 2.5.5 Data Management and Report Writing ............................................................................. 21 2.5.6 Data Analysis .................................................................................................................... 22 2.6 Response Rates ............................................................................................................................... 22 2.6.1 Facility Response Rate...................................................................................................... 22 2.6.2 Provider Interview ............................................................................................................ 25 2.6.3 Client Observation and Interview ..................................................................................... 26 Contents • iii 3 FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, AND SUPPORT ...... 29 3.1 Background ..................................................................................................................................... 30 3.2 Availability of Services ................................................................................................................... 30 3.2.1 Overall Availability of Specific Client Services ............................................................... 30 3.2.2 Availability of Basic Client Services ................................................................................ 32 3.3 Service Readiness: Basic Facility Infrastructure to Support Quality Service Provision ................. 34 3.3.1 Basic Amenities ................................................................................................................ 34 3.3.2 Basic Equipment to Support Quality Health Services ...................................................... 36 3.3.3 Standard Precautions for Infection Control in Service Delivery Area .............................. 38 3.3.4 Capacity for Adherence to Standards for Quality Sterilisation or High-level Disinfection Processes .....................................................................................................
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