Kapuya Hussein Athuman, Maluka Stephen Oswald, Hurtig Anna-Karin, Sebastian Miguel San
Dar es Salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania.
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Arch Public Health. 2024 Oct 29;82(1):194. doi: 10.1186/s13690-024-01415-0.
Tanzania has been promoting community participation in health, either directly or through health facility governing committees (HFGCs), as part of its wider, ongoing health system reforms since the 1990s. Although some studies have assessed the functioning of the HFGCs, little is known about community knowledge and involvement in their activities.
A cross-sectional survey assessing community awareness and participation in HFGCs was conducted between July and October 2022, involving two rural districts of Tanzania, which were selected based on their performance: Handeni, showing low performance and Mbarali, high performance. A total of 1,184 household heads living in the catchment areas of diverse facilities were involved. Frequencies and percentages were calculated overall and by district. The Chi-squared test was applied to assess statistically significant differences in knowledge, awareness, and participation between the districts.
The results revealed that 85.3% of the participants were unaware of the presence of the HFGCs and 91.7% did not know their roles. Additionally, 87% had neither heard nor seen any announcement about the selection of committee members. Only 14.5% considered that HFGCs were accountable to the community. While 96.7% of the respondents said they had never received any feedback from the HFGCs, only 8.1% reported that HFGCs were collecting views from the community. Regarding participation, 79.9% believed that the community had not been supporting their activities; however, 44.7% believed that the committees were important in improving health service delivery. Feedback and support were more common in Handeni.
The level of community awareness of and participation in HFGCs was very low in both districts. The Ministry of Health and the President's Office of Regional Administration and Local Government should implement an action plan to raise community awareness of the role of the HFGCs and their significance in promoting social accountability within the Tanzanian health system.
自20世纪90年代以来，作为其更广泛、持续进行的卫生系统改革的一部分，坦桑尼亚一直在促进社区直接或通过卫生设施管理委员会（HFGCs）参与卫生工作。尽管一些研究评估了卫生设施管理委员会的运作情况，但对于社区对其活动的了解和参与情况知之甚少。
2022年7月至10月进行了一项横断面调查，评估社区对卫生设施管理委员会的认识和参与情况，涉及坦桑尼亚的两个农村地区，这两个地区是根据其表现选定的：表现较差的汉德尼和表现较好的姆巴拉利。共有1184名居住在不同设施集水区的户主参与。总体和按地区计算了频率和百分比。应用卡方检验评估各地区在知识、认识和参与方面的统计学显著差异。
结果显示，85.3%的参与者不知道卫生设施管理委员会的存在，91.7%的人不知道其作用。此外，87%的人既没有听说也没有看到关于委员会成员选拔的任何公告。只有14.5%的人认为卫生设施管理委员会对社区负责。虽然96.7%的受访者表示他们从未收到过卫生设施管理委员会的任何反馈，但只有8.1%的人报告说卫生设施管理委员会正在收集社区的意见。关于参与情况，79.9%的人认为社区没有支持他们的活动；然而，44.7%的人认为这些委员会对改善卫生服务提供很重要。反馈和支持在汉德尼更为常见。
两个地区社区对卫生设施管理委员会的认识和参与程度都非常低。卫生部以及区域行政和地方政府总统办公室应实施一项行动计划，以提高社区对卫生设施管理委员会的作用及其在促进坦桑尼亚卫生系统内社会问责制方面的重要性的认识。
