Advertisement

Disparities in availability of services and prediction of the readiness of primary healthcare to manage diabetes in Tanzania

Published:November 28, 2020DOI:https://doi.org/10.1016/j.pcd.2020.11.007

      Highlights

      • Availability of diabetes services were more in non-publicly health facilities.
      • There was a severe shortage of staff trained to manage diabetes.
      • Health centers have higher readiness to manage diabetes.

      Abstract

      Background

      The burdens of Non-communicable Diseases have overstretched health systems in developing countries. The study explores disparities in the availability of services and predicts the readiness of primary healthcare facilities to manage diabetes in Tanzania.

      Methods

      The study analyzed data from the 2014–2015 Tanzania Service Provision Assessment Survey. A total of 1142 primary healthcare facilities were included in this analysis. The Negative binomial regression models were fitted to predict each of selected independent variable that is associated with the readiness of primary healthcare to manage diabetes.

      Results

      The overall availability of services was significantly different across the type of facility and managing authority. In an adjusted model, the following were the predictors for a significant increase in readiness to manage diabetes: health center [β = 0.470], private facilities [β = 0.252], the performance of management meetings [β = 0.446], having source of fund other than government [β = 0.193,], and presence of medical doctors [β = 0.677].

      Conclusion

      The robust primary care systems to manage diabetes could be achieved by improving the readiness of primary healthcare facilities through optimizing the availability of diagnostic tools, basic medicines, medical doctors, and early release of a government fund to publicly-owned facilities.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organization (WHO)
        Noncommunicable Diseases Progress Monitor.
        World Health Organization, 2017 (Available from: https://reliefweb.int/report/world/noncommunicable-diseases-progress-monitor-2017 Accessed 17 Nov 2020)
        • Renzaho A.M.N.
        The post-2015 development agenda for diabetes in sub-Saharan Africa: challenges and future directions.
        Glob. Health Action. 2015; 8: 27600https://doi.org/10.3402/gha.v8.27600
        • Dalal S.
        • Beunza J.J.
        • Volmink J.
        • Adebamowo C.
        • Bajunirwe F.
        • Njelekela M.
        • et al.
        Non-communicable diseases in sub-Saharan Africa: what we know now.
        Int. J. Epidemiol. 2011; 40: 885-901https://doi.org/10.1093/ije/dyr050
        • Assah F.
        • Mbanya J.C.
        Diabetes in Sub-Saharan Africa. Diabetes Mellitus in Developing Countries and Underserved Communities.
        Springer International Publishing, Cham2017: 33-48https://doi.org/10.1007/978-3-319-41559-8_3
        • International Diabetes Federation (IDF)
        IDF Diabetes Atlas. 8th ed. International Diabetes Federation, 2017 (Available: http://www.diabetesatlas.org/ Accessed 17 Nov 2020)
        • MoHSW
        Tanzania Steps Survey Report Ministry of Health and Social National Institute for Medical in Collaboration With World Health.
        2013 (Available from https://www.who.int/ncds/surveillance/steps/UR_Tanzania_2012_STEPS_Report.pdf Accessed 17 Nov 2020)
        • Beaglehole R.
        • Epping-Jordan J.
        • Patel V.
        • Chopra M.
        • Ebrahim S.
        • Kidd M.
        • et al.
        Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care.
        Lancet. 2008; 372: 940-949https://doi.org/10.1016/S0140-6736(08)61404-X
        • Mwangome M.
        • Geubbels E.
        • Klatser P.
        • Dieleman M.
        Perceptions on diabetes care provision among health providers in rural Tanzania: a qualitative study.
        Health Policy Plan. 2017; 32: 418-429https://doi.org/10.1093/heapol/czw143
        • Peck R.
        • Mghamba J.
        • Vanobberghen F.
        • Kavishe B.
        • Rugarabamu V.
        • Smeeth L.
        • et al.
        Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey.
        Lancet Glob Heal. 2014; 2: e285-92https://doi.org/10.1016/S2214-109X(14)70033-6
        • Munga M.A.
        • Maestad O.
        Measuring inequalities in the distribution of health workers: the case of Tanzania.
        Hum. Resour. Health. 2009; 7: 4https://doi.org/10.1186/1478-4491-7-4
        • Shemdoe A.
        • Mbaruku G.
        • Dillip A.
        • Bradley S.
        • William J.
        • Wason D.
        • et al.
        Explaining retention of healthcare workers in Tanzania: moving on, coming to ‘look, see and go’, or stay?.
        Hum. Resour. Health. 2016; 14: 2https://doi.org/10.1186/s12960-016-0098-7
        • Ministry of Health and Social Welfare (MoHSW)
        Tanzania Service Availability and Readiness Assessment (SARA) 2012.
        2013: 92 (Available: https://ihi.eprints.org/2448/1/SARA_2012_Report.pdf Accessed 17 Nov 2020)
        • Bintabara D.
        • Mpondo B.C.T.
        Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: evidence from Tanzanian national survey. Musinguzi G, editor.
        PLoS One. 2018; 13e0192942https://doi.org/10.1371/journal.pone.0192942
        • Kavishe B.
        • Biraro S.
        • Baisley K.
        • Vanobberghen F.
        • Kapiga S.
        • Munderi P.
        • et al.
        High prevalence of hypertension and of risk factors for non-communicable diseases (NCDs): a population based cross-sectional survey of NCDS and HIV infection in Northwestern Tanzania and Southern Uganda.
        BMC Med. 2015; 13: 126https://doi.org/10.1186/s12916-015-0357-9
        • Nuche-Berenguer B.
        • Kupfer L.E.
        Readiness of sub-Saharan Africa healthcare systems for the new pandemic, diabetes: a systematic review.
        J. Diabetes Res. 2018; 2018: 1-12https://doi.org/10.1155/2018/9262395
        • Katende D.
        • Mutungi G.
        • Baisley K.
        • Biraro S.
        • Ikoona E.
        • Peck R.
        • et al.
        Readiness of Ugandan health services for the management of outpatients with chronic diseases.
        Trop. Med. Int. Health. 2015; 20: 1385-1395https://doi.org/10.1111/tmi.12560
        • Bekele A.
        • Getachew T.
        • Amenu K.
        • Defar A.
        • Teklie H.
        • Gelibo T.
        Service availability and readiness for diabetes care at health facilities in Ethiopia.
        Ethiop J Heal Dev. 2017; 31: 110-119
        • Armstrong-Hough M.
        • Kishore S.P.
        • Byakika S.
        • Mutungi G.
        • Nunez-Smith M.
        • Schwartz J.I.
        Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: a poisson analysis using the service availability and readiness assessment. Khan HTA, editor.
        PLoS One. 2018; 13e0192332https://doi.org/10.1371/journal.pone.0192332
        • United Republic of Tanzania (URT) and World Health Organization (WHO)
        Health Systems Profile in Tanzania.
        2004 (Available: http://mbaralidc.go.tz/storage/app/media/uploaded-files/Health-tanzania.pdf Accessed 17 Nov 2020)
        • Ministry of Health (MoH)
        National Package of Essential Health Interventions in Tanzania.
        2000 (Accessed 17 Nov 2020)
        • Ministry of Health and Social Welfare (MoHSW)
        The United Republic of Tanzania Standard Treatment Guidelines and Essential Medicines List Ministry of Health and Social Welfare. fourth edition. 2013 (Accessed 17 Nov 2020)
        • WHO/HAI
        Measuring Medicine Prices, Availability, Affordability and Price Components. 2nd edition. Geneva, Switzerland, 2008 (Available: http://apps.who.int/iris/handle/10665/70013 Accessed 17 Nov 2020)
        • Ewen M.
        • Zweekhorst M.
        • Regeer B.
        • Laing R.
        Baseline assessment of WHO’s target for both availability and affordability of essential medicines to treat non-communicable diseases. Podobnik B, editor.
        PLoS One. 2017; 12e0171284https://doi.org/10.1371/journal.pone.0171284
        • Nyarko K.M.
        • Ameme D.K.
        • Ocansey D.
        • Commeh E.
        • Markwei M.T.
        • Ohene S.-A.-A.
        Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana.
        Pan Afr. Med. J. 2016; 25: 16https://doi.org/10.11604/pamj.supp.2016.25.1.6252
        • Islam M.R.
        • Laskar S.P.
        • Macer D.
        A study on service availability and readiness assessment of non-communicable diseases using the WHO tool for Gazipur District in Bangladesh.
        Bangladesh J Bioeth. 2016; 7: 1https://doi.org/10.3329/bioethics.v7i2.30785
        • Elias M.A.
        • Pati M.K.
        • Aivalli P.
        • Srinath B.
        • Munegowda C.
        • Shroff Z.C.
        • et al.
        Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India.
        BMJ Glob Heal. 2018; 2e000519https://doi.org/10.1136/bmjgh-2017-000519
        • World Health Organization (WHO)
        Global Report on Diabetes.
        2016 (doi:ISBN 978 92 4 156525 7)
        • Shaw J.E.
        • Sicree R.A.
        • Zimmet P.Z.
        Global estimates of the prevalence of diabetes for 2010 and 2030.
        Diabetes Res. Clin. Pract. 2010; 87: 4-14https://doi.org/10.1016/j.diabres.2009.10.007
        • Kruk M.E.
        • Nigenda G.
        • Knaul F.M.
        Redesigning primary care to tackle the global epidemic of noncommunicable disease.
        Am. J. Public Health. 2015; 105: 431-437https://doi.org/10.2105/AJPH.2014.302392
        • Kruk M.E.
        • Porignon D.
        • Rockers P.C.
        • Van Lerberghe W.
        The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives.
        Soc. Sci. Med. 2010; 70: 904-911https://doi.org/10.1016/j.socscimed.2009.11.025
        • World Health Organization
        Package of essential noncommunicable disease interventions for primary health care in low-resource settings.
        Geneva Wold Heal Organ. 2010; (doi:ISBN: 9789241598996)
        • Kengne A.P.
        • Mayosi B.M.
        Readiness of the primary care system for non-communicable diseases in sub-Saharan Africa.
        Lancet Glob Heal. 2014; 2: e247-e248https://doi.org/10.1016/S2214-109X(14)70212-8
        • Hancock C.
        • Kingo L.
        • Raynaud O.
        The private sector, international development and NCDs.
        Global. Health. 2011; 7: 23https://doi.org/10.1186/1744-8603-7-23
        • Basu S.
        • Andrews J.
        • Kishore S.
        • Panjabi R.
        • Stuckler D.
        Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. Jenkins R, editor.
        PLoS Med. 2012; 9e1001244https://doi.org/10.1371/journal.pmed.1001244
        • Bintabara D.
        • Nakamura K.
        • Seino K.
        Determinants of facility readiness for integration of family planning with HIV testing and counseling services: evidence from the Tanzania service provision assessment survey, 2014–2015.
        BMC Health Serv. Res. 2017; 17: 844https://doi.org/10.1186/s12913-017-2809-8
        • Lee B.
        • Tarimo K.
        Analysis of the Government of Tanzania Budget Allocation to the Health Sector for Fiscal Year 2017 / 18. Policy Br.
        2018 (Available: http://www.healthpolicyplus.com/ns/pubs/7183-7323_TanzaniaBudgetAllocationHealthSectorBrief.pdf Accessed 17 Nov 2020)