Follow-up Survey on Knowledge, Attitude and Practice (KAP) Concerning Health Sector Reform (HSR) in Kongwa, Kondoa and Dodoma Urban

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Full Title Follow-up Survey on Knowledge, Attitude and Practice Concerning Health Sector Reform (HSR) in Kongwa, Kondoa and Dodoma Urban.   Short Title KAP  Project Leader Selemani S. Mbuyita  Description The Community Based Health Initiatives (CBHI) Project has been implemented in 3 Districts in Dodoma Region (Kongwa, Kondoa and Dodoma Urban) since July 2004. In general, the project aimed at enabling community groups to better use of available resources to improve their health and contribute to the HSR. In May 2008, Community Based Health Initiatives (CBHI) project contracted Ifakara Health Institute (IHI) to undertake a baseline survey for its activities implemented in three districts of Dodoma region, namely Kongwa, Kondoa and Dodoma urban. The primary objective of the survey was to establish a benchmark on which the project would use to measure its success at the conclusion of the project activities. In August 2010 a follow up survey was requested. The objective was to determine levels of changes in knowledge, attitudes and practices (KAP) of communities in the same areas of exploration as was in the case of the baseline survey. Three additional districts (Mpwapwa, Chamwino and Bahi -in which CBHI project does not have activities) were included to provide a framework for comparison of CBHI influence in implementation districts. A total of 1528 interviews were conducted attaining a coverage and response rates of 92% and 99% respectively. Female respondents were 7.4% more than male respondents. About 74% of all respondents had primary education attainment and 21% had no education at all. More than 60% were classified social economically poor. Government health facilities were found to be the main provider of health services. There were several barriers to access of health services reported including distance to health facilities, transport and lack of emergency transport. Less than 50% of people have health facilities in their villages and more than 70% walk on foot when visiting health facilities. People associated quality of care they received with availability of drugs and sufficient number of staff. About 63% of respondents perceived health services to be generally good. During emergencies, savings, assistance from relatives and borrowing were reported to be the main coping mechanisms. Awareness of HSR is fairly good with more men being aware than women. Radio and health facilities were found to be the major sources of information about HSR. Knowledge on existence of exemptions and waivers was found to be as high as 80% and children under five, pregnant women, the elderly and disabled people were reported to be the main beneficiaries. Awareness of CHF/TIKA was found to be fairly good but the understanding of the concept declined significantly when compared to baseline survey results. Knowledge of the functions of HFGCs was found to be low. CBOs were sufficiently available and functional in many communities. More than 54% of surveyed households had no a household member participating in any CBO. Peoples’ awareness and knowledge about CBHI has increased significantly since 2008. Sufficiently high percentages of respondents could recall various messages. In conclusion, it was clear from this study that, the same factors which hindered access to quality health services as were found in the baseline survey have continued to be barriers in the follow up survey. Despite the fact that a significant percentage of respondents were satisfied with health services, quality of care is still far away from being attained. We recommend that, a plan and mechanism for sustenance of CBHI project good foundation and the way forward be put in place to continue addressing key issues of gender, poverty alleviation, improvement of knowledge, influencing positive attitude and good practice towards community health and wellbeing. A specific qualitative observation or literature review on gender relations in the context of the CBHI implementation district is recommended to improve gender inequalities and inequities found in this study. Finally, CBHI/GTZ should try to initiate a coordinated partnership with other stakeholders/partners in these districts to optimize use of resources and expertise in addressing the multiple problems and barriers to access to quality health services.  Collaborators Mary W. Kabla                GTZ   Fiona P. Chilunda            Community Based Health Initiatives (CBHI)   Abdallah Mkopi               Ifakara Health Institute                  Source of funding Swiss Development Cooperation (SDC)  Start Date May 2010                       End Date     March 2011

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