Background Star Rating Assessment (SRA) was initiated in 2015 in Tanzania aiming at improving the quality of services provided in Primary Healthcare (PHC) facilities. Social accountability (SA) is among the 12 assessment areas of SRA tools. We aimed to assess the SA performance and its predictors among PHC facilities in Tanzania based on findings of a nationwide reassessment conducted in 2017/18. Methods We used the SRA database with results of 2017/2018 to perform a cross-sectional secondary data analysis on SA dataset. We used proportions to determine the performance of the following five SA indicators: functional committees/boards, display of information on available resources, addressing local concerns, health workers’ engagement with local community, and involvement of community in facility planning process. A facility needed four indicators to be qualified as socially accountable. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine facilities characteristics associated with SA, namely location (urban or rural), ownership (private or public) and level of service (hospital, health centre or dispensary). Results We included a total of 3,032 PHC facilities of which majority were dispensaries (86.4%), public-owned (76.3%), and located in rural areas (76.0%). On average, 30.4% of the facilities were socially accountable; 72.0% engaged with local communities; and 65.5% involved communities in facility planning process. Nevertheless, as few as 22.5% had functional Health Committees/Boards. A facility was likely to be socially-accountable if public-owned [AOR 5.92; CI: 4.48–7.82, p = 0.001], based in urban areas [AOR 1.25; 95% CI: 1.01–1.53, p = 0.038] or operates at a level higher than Dispensaries (Health centre or Hospital levels) Conclusion Most of the Tanzanian PHC facilities are not socially accountable and therefore much effort in improving the situation should be done. The efforts should target the lower-level facilities, private-owned and rural-based PHC facilities. Regional authorities must capacitate facility committees/boards and ensure guidelines on SA are followed.

Background: The use of data for planning and improving healthcare delivery is sub-optimal among developing countries. In 2015, Tanzania started to implement the Star Rating Assessment (SRA) process for Primary Health Care (PHC) facilities to improve various dimensions of quality of services, including the use of data. We aimed at assessing the extent and predictors of data use in Tanzanian PHC facilities. Methods: We used the most current national SRA data available in DHIS2 that was collected in 2017/2018 from all 7289 PHC facilities. A facility was considered using data if gained 80% of the allocated scores. Other dependent variables were the three components that together contribute to the use of data (If PHC facility has Health Management Information Systems (HMISs) functional, disseminates information, and has proper medical records). We determined the association between data use and facility ownership status (public or private), location of the facility (rural or urban), gender of the facility in charge, and facility service level (dispensary, health centre, or hospital). Results are presented as proportions of facilities that

Background Client service charter (CSC) provides information about what people can expect in a facility’s services; what is expected of clients and service providers. Tanzania implemented Star Rating Assessment (SRA) of primary health care (PHC) facilities in 2015/16 and 2017/18 using SRA tools with 12 service areas. This paper assesses the status of service area 7, namely client focus that checked if client was satisfied with services provided and implementation of CSC through three indicators–if: CSC was displayed; CSC was monitored; client feedback mechanism and complaints handling was in place. Methods We extracted and performed a cross-sectional secondary data analysis of data related to clients’ focus that are found in national SRA database of 2017/2018 using STATA version 15. Client satisfaction was regarded as dependent variable while facility characteristics plus three indicators of CSC as independent variables. Multivariate logistic regression with p-value of 5% and 95% confidence interval (CI) were applied. Results A total of 4,523 facilities met our inclusion criteria; 3,987 (88.2%) were dispensaries, 408 (9.0%) health centres and 128 (2.8%) hospitals. CSC was displayed in 69.1% facilities, monitored in 32.4% facilities, and 32.5% of the facilities had mechanisms for clients’ feedback and handling complaints. The overall prevalence of clients’ satisfaction was 72.8%. Clients’ satisfaction was strongly associated with all implementation indicators of CSC. Clients from urban-based facilities had 21% increased satisfaction compared rural-based facilities (AOR 1.21; 95%CI: 1.00–1.46); and clients from hospitals had 39% increased satisfaction compared to dispensaries (AOR 1.39; 95%CI: 1.10–1.77). Conclusion The implementation of CSC is low among Tanzanian PHC facilities. Clients are more satisfied if received healthcare services from facilities that display the charter, monitor its implementation, have mechanisms to obtain clients feedback and handle complaints. Clients’ satisfaction at PHC could be improved through adoption and implementation of CSC.

Background Accurate and reliable diagnosis is the cornerstone of disease management and control. A reliable and properly organized laboratory system not only generates information critical to individual case management but also to disease surveillance, control, and outbreak management. This study presents the status of quality of laboratory services in Tanzania after a nationwide quality assessment, Star Rating Assessment (SRA) of PHC facilities conducted in 2017/18. Methods This was a cross-sectional study using secondary data from SRA dataset. Eight indicators were used to measure quality of laboratory services; of which together with facility characteristics are considered independent variables. Dependent variable is the general scores for laboratory services during SRA. Firstly, proportions of facilities for the indicators was calculated. Then, multiple linear regression was employed to determine impact of each variable on quality of laboratory services. P-value of < 0.05 was considered significant. Results Approximately one-quarter of 6,663 PHC facilities included, i.e., 1,773(26.6%) had appropriate staffing level for qualified health laboratory personnel. The situation was better in private facilities compared to public facilities (63% vs 19%, p<0.001); and in urban-based facilities compared to rural-based facilities (62% vs 16%, p<0.001). None of the indicators was complied with at least half of the facilities. Three indicators were the strongest positive predictor of laboratory quality scores: having a laboratory safety system (Beta = 3.403), availability of essential laboratory tests with SOPs available and adhered (Beta = 2.739), and appropriate staffing level for laboratory personnel (Beta = 1.498). The scores were likely to be low if the facility was a dispensary (Beta = -1.325), located in a rural area (Beta = -0.068) or publicly owned (Beta = -0.048). Conclusion There is a critical shortage of qualified laboratory personnel in PHC facilities, especially in public facilities that are based in rural areas. There is a need to further strengthen laboratory services in PHC facilities to ensure quality of laboratory test results, since none of the indicators was complied with at least half of the facilities