Sustainability of health benefits: Challenges faced by councils health management teams in sustaining comprehensive emergency care services after project phase out. The case of Rufiji, Kilombero and Ulanga districts
Bibliographic record
Abstract
Background: Attention to the sustainability of health intervention programs is increasing not only in developing countries but also in developed countries together with international development agencies. However, consensus on operational definitions of sustainability and determinants of sustainability is still at an early stage. While much progress has been made in the development of successful interventions to promote health, too few interventions achieve long term sustainability. Implementation of EMPOWER project in collaboration with World Lung Foundation (WLF) have increased accessibility of comprehensive emergency obstetric care (CEmOC) by upgrading health centers which were formerly not providing CEmOC services in the three rural districts in Tanzania. Although the WHO standards of CEmOC coverage in the project districts was above the requirement, but accessing these health facilities which provides CEmOC was so difficult due to various factors like geographical (mountains, rivers, seasonal roads), locations of these health facilities (like in one district the it was located at a corner of the district), unreliable referral system and poor functionality of these health facilities especially in terms of emergency preparedness etc. all these factors lead to less/poor accessibility to CEmOC. The upgraded facilities include Kibiti in Rufiji district, Mlimba in Kilombero district, Mwaya and Mtimbira in Ulanga district. Objective: To explore challenges of sustaining upgraded health centers and impact on service utilization after project phase out among rural communities in Tanzania.Methods: Purposeful criterion-based selection of the upgraded health centers (those providing CEmOC) was used in the three districts two years after project phase-out. Secondary data analysis of the quantitative data which was collected during and after the project was done. The following services were assessed; total number of facility deliveries, average number of cesarean section (CS), ante natal care (ANC) attendance, post natal care (PNC) attendance, family planning (FP) use and partograph to monitor the progress of labor. Qualitative data involved key informant interviews of council health management teams (CHMT) and facility in charges.Monitoring data, evaluation and observation of various CEmOC and MNCH related indicators were also done. Four upgraded health centers (Mwaya, Mtimbira, Mlimba and Kibiti) were used as case studies to generate learning reported in this paper.Results: Two years post project, the utilization of most of the services like number of deliveries and CS performed better and were maintained in upgraded health centers which receive regular assistance (Mwaya and Mlimba) than Kibiti health center which received minimal support. Health workers remained committed to sustain the practices promoted in the interventionsdespite of the noted challenges.Conclusions: Benefits of introduced health innovations such as upgrading of health centers for CEmOC can only be sustained if a sustainability strategies are integrated at early stages of project design and carried forward in routine district health planning processes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".