Although recent reports have shown a dramatic drop of malaria burden in Tanzania, some parts still have prevalence of >50%. Thus, current interventions might be insufficient and less likely to achieve malaria elimination targets. This study was conducted to establish health system factors which might be associated with the observed malaria resilience and recommend new strategies for malaria control.
The study was conducted in eight councils of Uvinza and Buhigwe (Kigoma); Chato and Nyang’hwale (Geita); Nanyumbu and Mtwara DC (Mtwara) and Nyasa and Tunduru (Ruvuma). Assessment of health facilities and accredited drug dispensing outlets serving 16 selected villages (two per council) was conducted from September to November 2017. Information on availability, accessibility, affordability and quality of malaria services was collected through observations, records review, exit interviews and providers’ interview.
A total of 31 health facilities (HFs) were assessed; including 6 hospitals (19.4%); 13 health centres (41.9%) and 12 dispensaries (38.7%). Over 31% were located between 0-10km from the district medical office while 41% were located less than 50kms and the rest were 50 -120 km. About 33% of the HFs had ≤ 5 health workers and some having only one, while four (12.9%) had no clinician. Suspected malaria cases were mostly checked on the presence of fever, its duration and their age. Taking history on previous treatment/medication was not adequately done. Late booking for antenatal care was observed among pregnant women and was more pronounced among women with high number of gravida.
Despite availability of HFs, accessibility and quality of services could be limited by long distance for referral at the district hospital and shortage of health workers. Patients were not properly assessed, and case management of pregnant women was more likely to be inadequate due to late booking for antenatal care.