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 Performance-based financing (PBF) is an important mechanism for improving the quality of health services in low- and middle- income countries. In 2014, Tanzania launched a country-wide quality approach known as Star Rating Assessment (SRA) aims to assess the quality of healthcare service delivery in all Primary Health Care (PHC) Facilities in the country. Furthermore, by 2015, the country rolled out RBF initiatives into eight regions in which PHC facilities were paid incentives based on their level of achievement in SRA assessments. This study aims to compare performance in quality between PHC facilities under RBF regions and non-RBF regions using the findings from the two-phases SRA assessments; baseline (2015/16) and follow-up (2017/18). Methods Analysis of performance of SRA indicators in the SRA service areas were identified based on the star rating tool that was used. The star rating tool had 12 service areas. For the sake of this implementation study, only seven service areas were included. The purposive sampling of the areas was used to select the areas that had direct influence of RBF in health facilities improvement. We used a t-test to determine whether there were differences in assessment star rating scores between the regions that implemented RBF and those which did not at each assessment (both baseline and reassessment). All results were considered significant at p < 0.05. The 95% Confidence Interval was also reported. Results The mean value was found to be 61.26 among facilities exposed to RBF compared to 51.28 among those not exposed to RBF. The study showed the mean difference score to be 10.79, with a confidence interval at 95% to be -1.24 to 22.84, suggesting that there was (no) a significant difference in the facilities based on RBF exposure during baseline assessment. The p-value of 0.07 was not statistically significant. Overall, there was an increment in facilities scoring the recommended 3+stars and above by 17.39% between the assessments, the difference was significant (p=0.0001). When the regions were stratified based on RBF intervention; facilities under RBF improved in 3+ stars by 10.63% higher compared to those that were not under RBF; however, the difference was not statistically significant (p=0.06) Conclusion Improvement of Health services needs to adhere to all six WHO building blocks and note to a sole financing. The six WHO building blocks are (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance. Probably, RBF found not to influence star rating because other blocks were not considered in this intervention. We need to integrate all the six WHO building blocks whenever we want to improve health services provision.

Introduction: The need to address the problem of patient safety has been a focus of World Health Assembly (WHA) meetings of 2002, 2019 and 2021. The 2019 WHA Resolution urged the Member States to take action on patient safety. We aimed to review patient safety efforts in Tanzania from 2002 to 2022 to inform improvement efforts towards the 2030 target. Methods: A rapid literature review was conducted between January 2002 and April 2022.We searched Google, PubMed and PubMed Central in April and May 2022 using the following search terms: PubMed-"patient safety Tanzania", "blood safety in Tanzania", "safe surgery Tanzania", and "healthcare-associated infections Tanzania"; Google-"blood safety in Tanzania", injection safety in Tanzania", "infection prevention and control", "radiation safety in health facilities in Tanzania"; and PubMed Central-"injection safety in Tanzania. Results: The search identified 4160 articles, of which 4053 were removed in initial screening; 21 were duplicates, giving 86 relevant articles for full screening. Of the 86 articles, 04 were removed after the full screening, hence remaining with 82 articles. Among the 82 eligible articles, 27 are on IPC, 26 on safe surgery, 12 on blood safety, 07 on radiation safety, 06 on injection safety, and 02 on medication safety. One article was relevant to-blood safety, IPC and injection safety; and one article was relevant to-IPC and injection