‘We do not do any activity until there is an outbreak’: barriers to disease prevention and health promotion at the community level in Kongwa District, Tanzania

Figures & data

Fig. 1 Conceptual Framework. Source: Adapted from Saachy et al. (29).

Fig. 2 Organization structure of a decentralized health system. Source: Modified from the figure on interlinks between central and local government structures (Molel, 2010).

Table 1 Study respondents

		Number
S/N	Category	Male	Female
1	CHMT members	5	2
2	Other key district officials (DPLO, DT, CCHS)	3	1
3	Heads of programs	2	2
4	Ward executive officers	2	0
5	Members of Village health committee	1	1
6	Members of health facility governing committee	2	1
6	Ward health officer	1	0
	Total	16	7

Table 2 Objectives, targets, and planned interventions for selected diseases – 2010/11

Problem	Objective	Target	Activity
High morbidity and mortality rate due to malaria	To reduce morbidity and mortality due to malaria by 50% by year, 2015 To reduce morbidity and mortality due to malaria by 7% by June 2011	1) Training to 20 health workers on malaria case mgt. 2) Commemoration of African Malaria day. 3) Computer training to malaria/IMCI data manager. To provide HATI PUNGUZO for all pregnant woman attending ANC by 100%.	1) Training to 20 health workers on malaria case management. 2) Commemoration of African Malaria day. 3) Computer training to malaria/IMCI data manager. To provide HATI PUNGUZO for all pregnant woman attending ANC by 100%.
High morbidity and mortality rate due to communicable diseases such as, Diarrhea Tuberculosis and HIV/AID/STI	To increase proportion of TB cases completed treatment from 97 to 100% by June 2009 To reduce STI/HIV/AID cases	To increase case mgt ability and case detection in all 41 HF. Reduce HIV infection from 3.1 to 2.0%.	To train 20 clinician/nurses on proper case management for 4 days. Tracing of defaulters Conduct supportive supervision to 41 health facilities. 1) Training 20 health providers on proper management of STI. 2) Training of 20 COs on syndomic case management. To conduct supportive supervision on syndomic case management to 41 health facility.

Source: Kongwa Comprehensive Council Health Plan for the Year 2010/2011.

Table 3 Allocation ceiling for the health basket fund and block grant (other charges)

Cost center	Ceiling range for allocation by council (%)
Office of District Medical Officer (DMO)	15–20
Council hospital/CDH	25–30
Voluntary agency hospitals (VAH)	10–15 (health basket funds only)
Health centers	15–20
Dispensaries	20–25
Community initiatives	2–5

Source: URT (24).

Table 4 Performance budget framework for 2012/13 – Cost Centre E07 Community Health Initiatives/Promotion

		Details
Intervention	Activity	Description	Unit	Qty	Unit cost	Output indicator
Case management (diagnosis and treatment) of locally important	To conduct NTDs Outreach at community and conduct BTRP Surgeries BY June 2013	Petrol	Liters	1	600,000.00	Number of outreach conducted
diseases and neglected tropical diseases		Diesel	Liters	776.0	2,500.00
		Per diem – domestic	Person	1.0	1,950,000.00
Promotion and prevention predisposing factors for NTDs at community level	To sensitize community on NTDs through commemoration of vision world sight meetings by June 2013	Per diem – domestic	Person	1.0	195,000.00	Activity report presented
		Ground travel (Bus, Railway, Taxi)	Liters	1.0	20,000.00
Mobilized adequate funding for health and social welfare services (CHF, NHIF, P4P, User Fees etc.)	Community sensitization on CHF at 22 wards by June 2013	Per diem – domestic	Can	1.0	990,000.00	Number of household enrolled
		Fuel	Person	1.0	440,000.00
Proper disposal of hazardous waste, solid and liquid waste	To procure waste handling material for Mlali Health Centre by June 2013	Cleaning supplies	Person	1.0	1,000,000.00	Number of waste handling materials procured
TB DOTS Plus (TB HIV, MDR – TB)	To sensitize community on TB through commemoration of world TB day by June 2013	Extra-duty	Person	1.0	250,000.00	Number of meetings conducted
		Food and refreshment	Person	1.0	125,000.00
		entertainment	Lump sum	1.0	200,000.00
		Fuel	Liters	1.0	100,000.00
Integrated management of childhood illnesses (IMCI)	To conduct mentoring of IMCI to 80 health staff in 30 HFs by June 2013	Special needs material and supplies	Person days	1.0	1,260,000.00	Number of health staff mentored
Provision of safe clean water hygiene and sanitation	To procure waste handling materials at 54 HFs by June 2013	Water and waste disposal	Quarter	1.0	5,928,300.00	Number of waste handling materials procured

Source: Kongwa District Council – Performance Budget Framework (MTEF) 2012/13.

Saachy N, Sanders D, Kruger N. Overview of health sector reforms in South Africa. Final Report. 2011; London: DFID Human Resources Development Centre.

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United Republic of Tanzania (URT). Comprehensive health planning guidelines. 2011; Dar es Salaam: Ministry of Health and Social Welfare and Prime Minister's Office Regional Administration and Local Government.

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