Service Availability

and Readiness
Assessment
SARA
DECEMBER 2017
MINISTRY OF HEALTH COMMUNITY DEVELOPMENT
GENDER ELDERLY AND CHILDREN
TABLE OF CONTENT Table of Contents III
List of tables IV
List of figures VI
1 Foreword VIII
2 Acknowledgement X
3 Executive Summary XII
4 Acronyms XV
5 Key Results XVIII
5.1 General Service Availability XIX
5.2 General Service Readiness XIX
5.3 Maternal and Child Health Service XX
6 Introduction 1
7 Methodology and Data collection 3
7.1 Planning process 4
7.2 Selection of Health Facilities 4
7.3 Sample and Sample Weights 4
7.4 Data collection and analysis 4
8 Service Availability 6
8.1 Distribution of facilities 7
8.2 Facility density 8
9 General Service Readiness 11
9.1 Basic Amenities 12
9.2 Basic equipment 13
9.3 Standard precautions for infection control 13
9.4 Diagnostic capacity 14
9.5 Essential medicines 15
9.6 General service readiness 16
10 Service specific availability and readiness 17
11 Maternal, newborn and child health 19
11.1 Family planning 20
11.2 Antenatal care 25
11.3 Prevention of mother-to-child transmission of HIV 29
11.4 Obstetric and newborn care 30
11.5 Comprehensive obstetric care 32
11.6 Child immunization services 33
12 Child and Adolescent Health 36
12.1 Child preventive and curative services 37
12.2 Adolescent reproductive health services 40
13 Communicable Diseases 42
13.1 HIV counselling and testing 43
13.2 HIV care and support 44
13.3 Sexually Transmitted Infections 46
13.4 Tuberculosis 49
13.5 Malaria 55
14 Non-Communicable Diseases 57
15 Surgical services 65
15.1 Basic surgery services 66
15.2 Comprehensive surgical services 68
15.3 Blood transfusion 70
16 Diagnostics 72
17 Conclusion 77
18 References 79
19 Field Team 81
LIST OF TABLE
Table 8.1
Distribution of sampled and interviewed health facilities by facility type managing authority
and location of the health facility 7
Table 8.2
Distribution of health facilities in each of sampled district by facility type 8
Table 8.3
Density of core health care professionals per 10 000 population, according to level of service,
managing authority and location of the health facility 9
Table 8.4
Number of health facilities per 10 000 population 10
Table 11.1
Percentage of facilities with family planning items available (N=549) 23
Table 11.2
Percentage of facilities that offer antenatal care services (N=549) 26
Table 11.3
Percentage of facilities that have tracer items for antenatal care services among facilities
that provide ANC services 27
Table 11.4
Percentage of facilities offering PMCTC services (N=549) 29
Table 11.5
Percentage of facilities offering CemOC services 32
Table 12.1
Percentage of facilities that offer child health preventative and curative care services (N=549) 38
Table 12.2
Adolescent health availability 40
Table 12.3
Percentage of facilities that have tracer items for adolescent health services among facilities
that provide this service (n=287) 41
Table 13.1
Percentage of health facilities offering HIV counselling and testing services (N=549) 43
Table 13.2
Percentage of facilities that have tracer items for HIV counselling and testing services among
facilities that provide this service (n=467) 44
Table 13.3
Percentage of facilities offering STI services (N=549) 46
Table 13.4
Sexually transmitted infections readiness 49
Table 13.5
Percentage of facilities that offer tuberculosis services (N=549) 51
Table 13.6
Percentage of facilities that have tracer items for tuberculosis services among facilities that
provide this service (n=279) 53
Table 13.7
Percentage of facilities that offer malaria services (N=549) 55
Table 14.1
Percentage of facilities that offer diabetes services (N=549) 58
LIST OF TABLE
Table 14.2
Percentage of facilities offering CVD diagnosis and management services (N=549) 60
Table 14.3
Percentage of facilities that offer chronic respiratory disease services (N=549) 62
Table 14.4
Percentage of facilities that offer cervical cancer services (N=549) 63
Table 14.5
Percentage of facilities that have tracer items for cervical cancer services among
facilities that provide this service (n-127) 64
Table 15.1
Percentage of facilities that offer blood transfusion services (N=549) 70
Table 15.2
Percentage of facilities that have tracer items for blood transfusion services among
facilities that provide this service (n=79) 71
Table 16.1
Percentage of hospitals with advanced diagnostic capacity (n=53) 73
Table 16.2
Percentage of hospitals that offer advanced diagnostic services (n=53) 75
LIST OF FIGURES
Figure 3.1
Overall general service availability and readiness Index and domain scores XIII
Figure 3.2
General service readiness index and domain score by district (N=549) XIV
Figure 9.1
Percentage of facilities with basic amenities items available 12
Figure 9.2
Percentage of facilities with basic equipment available (N=549) 13
Figure 9.3
Percentage of facilities with standard precaution for infection control items available 14
Figure 9.4
Percentage of facilities with diagnostic items available 15
Figure 9.5
Percentage of facilities with essential medicines items available 15
Figure 9.6
General service readiness index and domain scores 16
Figure 11.1
Percentage of facilities that offer family planning services (N=549) 21
Figure 11.2
Percentage of facilities that offer antenatal services (N=549) 25
Figure 11.3
Percentage of facilities that have tracer items for PMTCT among facilities that provide this
services (n=409) 29
Figure 11.4
Percentage of facilities that offer basic obstetric care services (N=549) 30
Figure 11.5
Percentage of facilities that have tracer items for basic obstetric care among facilities that
provide delivery services (n=375) 31
Figure 11.6
Facilities with delivery services that have tracer items for comprehensive obstetric care
services (n=89) 33
Figure 11.7
Percentage of facilities with immunization services available (N=549) 34
Figure 11.8
Percentage of facilities that have tracer items for child immunization services among facilities
that provide immunization services (n=415) 35
Figure 12.1
Percentage of facilities that offer child health preventative and curative care services (N=549) 37
Figure 12.2
Percentage of facilities that have tracer items for child health preventative and
curative care services among facilities that provide this service (n=475) 39
Figure 12.3
Percentage of facilities that have tracer items for adolescent health services among facilities
that provide this service (n=287) 41
LIST OF FIGURES
Figure 13.1
Percentage of facilities that offer HIV/AIDS care and support services (N=549) 45
Figure 13.2
Percentage of facilities that have tracer items for HIV care and support services among
facilities that provide this service (n=314) 45
Figure 13.3
Percentage of facilities that have tracer items for STI services among facilities that provide
this service (n=503) 47
Figure 13.4
Percentage of facilities that have tracer items for malaria services among facilities that
provide this service (n=545) 56
Figure 14.1
Percentage of facilities that have tracer items for diabetes services among facilities that
provide this service (n=308) 59
Figure 14.2
Percentage of facilities that have tracer items for cardiovascular disease services among
facilities that provide this service (n=355) 61
Figure 14.3
Percentage of facilities that have tracer items for chronic respiratory disease services among
facilities that provide this service (n=295) 63
Figure 15.1
Percentage of facilities that offer basic surgical services 67
Figure 15.2
Percentage of facilities that have tracer items for basic surgical services among facilities
that provide this service 68
Figure 15.3
Percentage of hospitals that offer comprehensive surgical services 69
Figure 15.4
Percentage of hospitals that have tracer items for comprehensive surgical services among
facilities that provide this service 70
FOREWORD

1
The Tanzania “Service Availability and Readiness Assessment” SARA provides a snapshot of the current
status of health service provision in Mainland Tanzania in 2017. This is the second SARA report after the
first one that was published in 2012. The study used a standard questionnaire instrument and indicators
developed by the World Health Organization (WHO) Data for the study were collected from a sample of
26 districts and more than 540 health facilities to provide a representative portrayal of health services in
Mainland Tanzania. The SARA 2017 report provides detailed information on the distribution of hospitals,
health centers and dispensaries, provides estimates of general health care availability and readiness as
well as the availability of specific services and the capacity of these facilities to deliver services to the
expected levels and standards at national and international levels.

The publication represents a major contribution to effective monitoring of health service delivery in the
country. In addition to filling an immediate information gap, SARA 2017 provides a situational assessment
for effective decision making and planning. The report also responds to the increased demand for
accountability by publishing objective measures of service delivery capability. In highlighting areas of
strength and weakness, the report will also aid health planners and managers to prioritize effort and
efficiently allocate resources. The planning, execution, analysis and report writing of the assessment was
done by local institutions Ifakara Health Institute (IHI) & Muhimbili University of Health and Allied Sciences
(MUHAS), with support from Khulisa Management Services (from South Africa) and experts from the
World Health Organization. These efforts were led by the Monitoring and Evaluation unit of the
Department of Policy and Planning, Ministry of Health Community Development, Gender Elderly and
Children.

It is my hope that this report will be used by all stakeholders in the health sector in order to raise standards
in delivering health care services. We look forward to repeating the survey at regular intervals in order to
assess the results of our collective efforts in improving health outcomes of our people. On behalf of the
Ministry of Health Community Development, Gender Elderly and Children, I would like to express my
sincere appreciation to the Global Fund to fight AIDS, Tuberculosis and Malaria for providing the financial
support required for this study and to Ifakara Health Institute for providing technical and editorial support
in conducting the survey and producing the report.

Prof. Muhammad Bakari Kambi

Chief Medical Officer,
,
Ministry of Health Community Development, Gender Elderly and Children
ACKNOWLEDGEMENT

2
The Ministry of Health Community Development, Gender Elderly and Children wishes to gratefully
acknowledge the contribution of multiple organizations and individuals to the successful accomplishment
of the Tanzania Service Availability and Readiness Assessment 2017.

Ifakara Health Institute (IHI) conducted the survey, analyzed the data and prepared the report for
publication. Dr. Honorati Masanja, Dr. Fatuma Manzi and Mr. Charles Festo authored the final report.
Appreciation is also to the personnel visited in respective health facilities, Regional and District HMIS
Coordinators in all of the sample districts for recording and compiling the data on which this survey was
based. The final report benefited from a critical review of a draft by the Ministry of Health Community
Development, Gender Elderly and Children (MOHCDGEC), Khulisa Management Services. Sincere thanks
also go to Ms. Ashley Sheffel and Dr. Benson Droti, SARA experts at the John’s Hopkins University and the
World Health Organization, Geneva, respectively for their readiness to provide assistance whenever it was
needed.

Overall coordination of the exercise was provided by the Monitoring and Evaluation Section of the Ministry
of Health Community Development, Gender Elderly and Children. This work would not been possible
without the oversight support of the Health System Strengthening Coordination Unit of the MOHCDGEC.

Finally, we acknowledge the financial support of the Global Fund to fight AIDS, Tuberculosis, and Malaria,
without which the study would not have been possible.

Dr. Mpoki M. Ulisubisya

Permanent Secretary,
Ministry of Health Community Development, Gender Elderly and Children
EXECUTIVE
SUMMARY

3
 The 2017 Service Availability and Readiness Assessment (SARA) Tanzania was conducted to assist the
health sector in assessing and monitoring service availability and readiness and capacity at the district and national
level. SARA 2017 was conducted from 2nd-21st October 2017 by the Ifakara Health Institute in collaboration with the
Ministry of Health Community Development Gender Elderly and Children’s (MOHCDGEC) Monitoring and Evaluation
Section. Khulisa Management Services (Khulisa), a South African consultancy company hired by The Global Fund
quality assured the work from sampling methodology, the adaptation of the questionnaires, pilot testing, and training
of research assistants, field work and analysis of data. This is the second SARA survey to be conducted in Tanzania.
The first assessment was conducted in 2012.

General Service Readiness index is a composite measure designed to combine information from the
five general services readiness domains: basic amenities, basic equipment, standard precautions, laboratory
diagnostics and medicines. For readiness each domain, the average availability was calculated using a set of standard
tracer items that were adapted for Tanzania.

100%

90%
82%
80%

70% 65%
57%
60%
52%
50%
Index

50%
38%
40%

30%

20%

10%

0%
General service Standard Basic amenities Basic Diagnostics Essential
readiness index precautions mean score equipment mean score medicines mean
mean score mean score score

FIGURE 3.1
Overall general service availability and readiness Index and domain scores

Figure 3.1 shows the overall general services readiness (GSR) index and general services domain scores for 2017
assessment. The twenty six districts of Mainland Tanzania that participated in the assessment were; Monduli,
Kinondoni, Dodoma, Chato, Mufindi, Muleba, Mpanda, Buhigwe, Mwanga, Lindi, Mbulu, Butiama, Rungwe, Kilosa,
Mtwara, Magu, Ludewa, Kisarawe, Nkasi, Tunduru,Kishapu, Busega, Iramba, Momba, Kaliua and Lushoto. The general
service readiness index (GSR) score was 57%. Basic amenities domain was the highest with a mean score of 82 out of
100 while essential medicines scored the lowest with a mean score of 38 out of 100. Over the five domains, Kinondoni
district had the highest general service readiness index score with a mean index of 74%. Two districts of Lushoto and
Momba districts had the lowest scores with mean index scores of 47% and 48% respectively Figure 3.2

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 120%

100%

80%
Index

60%

40%

20%

57% 65% 74% 65% 50% 50% 60% 56% 63% 51% 62% 56% 50% 59% 54% 61% 57% 53% 65% 50% 53% 59% 52% 55% 48% 59% 47%
0%

Basic amenities mean score Basic equipment mean score Standard precautions mean score

Diagnostics mean score Essential medicines mean score

FIGURE 3.2
General service readiness index and domain score by district (N=549)

Service availability and readiness was also assessed on 19 specific areas of service provision. Availability of a particular
service implied that sampled facilities reported that they offered the specific service in question on the day of the
survey. “Readiness” as a composite measure was restricted to a sub-set of facilities that offered the service. The
component “domains” that make up the readiness score differed from service to service, but generally included:
Staffing & training; Equipment; Medicines & Supplies, and Diagnostics.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
ACRONYMS

4
ACRONYMS
AIDS Acquired immune deficiency syndrome
ANC Antenatal care
ART Antiretroviral therapy
BCG Bacillus Calmette-Guérin
CD4 Cluster of differentiation 4
CEmOC Comprehensive emergency obstetric care
CRD Chronic respiratory disease
CVD Cardiovascular disease
DHS Demographic and health survey
DOTS Directly Observed Treatment - Short course
DTP Diphtheria tetanus pertussis
EFV Efavirenz
EPI Expanded programme on immunization
FBO Faith based organization
FP Family planning
GSR General service readiness
HepB Hepatitis B
HiB Haemophilus influenzae type B
HIV Human immunodeficiency virus
HMIS Health management information system
IHFAN International Health Facility Assessment Network
IHI Ifakara Health Institute
IMCI Integrated Management Of Childhood Illness
IMEESC Integrated Management Of Emergency And Essential Surgical Care
IMPAC Integrated Management Of Pregnancy And Childbirth
IPT Intermittent Preventive Treatment
ITN Insecticide Treated Net
IUD Intrauterine Device
IV Intravenous
M&E Monitoring And Evaluation
MCH Maternal And Child Health
MDG Millennium Development Goal
MDR-TB Multiple Drug-Resistant Tuberculosis
MNCH Maternal, Neonatal And Child Health
MOHCDGEC Ministry of Health Community Development Gender Elderly and Children
MVA Manual Vacuum Aspiration
NCD Non-Communicable Disease
NGO Non-Governmental Organization
NVP Nevirapine
OI Opportunistic Infection
OPV Oral Polio Vaccine
ACRONYMS
ORS Oral Rehydration Solution
PCV Pneumococcal Conjugate Vaccine
PMI President’s Malaria Initiative
PMTCT Preventing Mother-To-Child Transmission
PHU Peripheral Health Unit
RDT Rapid Diagnostic Test
SAM Service Availability Mapping
SARA Service Availability And Readiness Assessment
SP Sufadoxine Pyrimethamine
SPA Service Provision Assessment
STI Sexually Transmitted Infection
TB Tuberculosis
TT Tetanus Toxoid
TSPA Tanzania Service Provision Assessment
USAID United States Agency For International Development
WHO World Health Organization
ZDV Zidovudine
KEY
RESULTS

5
5.1 GENERAL SERVICE AVAILABILITY

•The density of health facilities was 1.87 per 10,000 population in the 26 districts combined. Of all sampled health
facilities 44 percent were owned and operated by the government. Dispensaries comprised of 51 percent of the
sample of government health facilities. Private for profit facilities made up 28 percent of the sample.
•The overall density of core health workers was 7.6 per 10,000 population. The health worker density varied by facility
and by managing authority. The average health worker density was 3.9 per 10,000 population in urban areas and 3.7
per 10,000 population in rural areas. The nursing profession constituted approximately two-thirds (63 percent) of the
health workforce in the 26 districts assessed.

5.2 GENERAL SERVICE READINESS

Basic amenities
•Three quarters (74 percent) of the facilities had a source of power (electricity grid, functional generator with fuel or
solar) on the day of the assessment.
•Two thirds (68 percent) of the health facilities had sanitation facilities
•The item with the lowest availability was emergency transportation. This was available in only 10 percent of health
facilities

Basic equipment
•Items such as blood pressure apparatus, stethoscope, thermometer and adults weighing scales were available in nine
out ten health facilities across the 26 districts
•Light source was the least available item across the 26 districts.
•Only one third (32 percent) of health facilities across the 26 districts had all the 6 basic items

Standard precautions
•Disposable or auto disable syringes (100 percent) and disinfectants (95 percent) were the most available items
across the 26 districts.
•Less than half of the facilities (45 percent) had guidelines for standard precautions for infection control
•Two thirds of the health facilities (68 percent) of the facilities across the districts had latex gloves

Diagnostic capacity
•Capacity to conduct diagnostics test was high for HIV (93 percent) and malaria (98 percent).
•Half of the health facilities across the 26 districts were able to perform urine test for pregnancy, and 58 percent had
the capacity to conduct syphilis test.
•Capacity to perform urine dipstick for protein, urine dipstick for glucose, haemoglobin and blood glucose ranged
between one quarter to one third of the health facilities.

Essential medicines
•The most common essential medicine found in health facilities across the 26 districts were ORS (90 percent),
Amoxicillin tablets (89 percent), Oxytocin injection (83 percent), Ceftriaxone (79 percent) and Magnesium Sulphate
injectable (73 percent).
•Essential medicines that were less likely to be found in-stock in the 26 districts were Fluoxetine tablets (1 percent),
Carbamazepine (3 percent), Beclometasone inhaler (3 percent), Haloperidol tablets (3 percent), Enalapril or
alternative ACE inhibitor (6 percent).

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
5.3 MATERNAL AND CHILD HEALTH SERVICE

Family planning
•Almost nine out of 10 health facilities offered family planning services
•Combined oral and progestin-only injectable were offered in three out of four health facilities across the 26 districts
•Male condoms were more likely (81 percent) to be offered at health facilities than female condoms (25 percent)
•Male (4 percent) and female sterilization (9 percent) were less common methods of family planning offered at health
facilities across the 26 districts

Antenatal care
•Antenatal services were offered in 9 out 10 health facilities across the 26 districts
•IPTp, monitoring of hypertensive disorders and tetanus toxoid services were available in over 80 percent of the health
facilities
•Less than half (46 percent) of the health facilities had at least one of the staff trained on ANC, and almost half (49
percent) had ANC guidelines available

Prevention of mother-to-child transmission (PMTCT) of HIV

•PMTCT of HIV services were offered in 84 percent of health facilities across the 26 districts.
•HIV diagnostic capacity for adults was high (98 percent)
•Staff and guidelines for PMTCT of HIV services were available in more than 60 percent of health facilities except for
staff trained on infant and young child feeding.
•Availability of Zidovudine syrup for paediatric cases was very low (1 percent) in health facilities across the 26 districts

Obstetric and newborn care

•Obstetric and newborn care was offered in 81 percent of the heath facilities across 26 districts
•The mean availability of obstetric signal functions was 59 percent, ranging from 52 percent for parenteral
administration of anti-convulsants to 66 percent for parenteral administration of oxytocic drugs.
•Availability of medicine and commodities for obstetric and newborn care was overall high, above 80%.
•Availability of equipment for obstetric and newborn care varied across health facilities in the 26 districts.
Emergency transport (9 percent), delivery beds (14 percent), manual vacuum extractor and vacuum aspirator (12
percent). Other items were such as delivery pack, gloves, partograph, blood pressure apparatus, infant weighing
scales and soap and running water were available in 85% of the health facilities surveyed.

Comprehensive obstetric care

•CEmOC services were commonly found in hospitals (81 percent) than in health centers, with 53 out 59 hospitals in
the sample providing the service
•Availability of staff trained in anaesthesia and surgery in the sample of hospitals providing CEmOC was high at 92
percent and 95 percent respectively.
•Though availability of staff trained on anaesthesia was high, availability of anaesthesia equipment was only 30
percent across hospitals in the sampled districts
•Blood supply safety was available in 72 percent of health facilities providing CEmOC services, whereas less than half
(46 percent) of the CEmOC facilities had blood supply sufficiency.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
Immunization
•84 percent of all health facilities offered routine child immunization services. Only 36 percent of private for profit
offered these services.
•Availability of routine immunization in rural health facilities was higher than in urban. 87 percent compared to 78
percent.
•Availability of the four antigens ranged from 85 percent for pneumococcal vaccine to 89 percent for both measles and
rotavirus and 90 percent for DPT-HB+HepB vaccine across the 26 districts

Child preventive and curative services

•Ninety-three percent of health facilities across the 26 districts offered child health preventative and curative care
services. Treatment of malaria, child growth monitoring and diagnosis or treatment of malnutrition was
approximately 90 percent.
•Rural health facilities offering child preventive and curative services were relatively better off than urban health facili-
ties with 95 percent compared to 87 percent offering the services.
•Availability of medicines and supplies was good. Availability of items ranged from 62 to 91 percent.
•Guidelines for IMCI were more available in health centers (82 percent) and dispensaries (76 percent), whereas staff
trained in IMCI were found to be more in hospitals (60 percent) and health centers (56 percent) than in dispensaries
(41 percent).

Adolescent and reproductive health services

•Adolescent health services were available in 63 percent of the sampled health facilities. Approximately 70 percent
health facilities offered HIV testing and counselling services to adolescents.
•Availability of family planning and ART services for adolescent was 60 percent and 36 percent respectively.
•Condoms and HIV diagnostic capacity were available in over 9 out of 10 health facilities offering adolescent and
reproductive services

HIV counselling and testing

•Availability of HIV counselling and testing services was high (92 percent) across the 26 districts.
•Guidelines for HIV counselling and testing were available in 70 percent of the facilities while just above half (52
percent) of the facilities had at least one staff trained in HIV counselling and testing.
•HIV diagnostic capacity was almost universal (99 percent) across the 26 districts

HIV care and support

•Half (51 percent) of the health facilities offered HIV care and support across the 26 districts.
•Medicine and commodities for HIV care and support were reasonably high; over 80 percent for most except for TB
medication (46 percent) and IV for treatment for fungal infections (13 percent)
•Guidelines for palliative care were available in less than half (42 percent) of health facilities across the 26 districts

Sexually transmitted infections

•Nine out of ten health facilities in the sampled districts offered STIs services
•Facilities offering diagnostic capacity and prescription of treatment for STIs was high at 86 and 89 percent
respectively.
•Availability of medicines and commodities was approximately 80 percent or above across health facilities in the 26
districts.
•Mean availability of tracer items for STIs was 70 percent.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Tuberculosis
•Overall, 43 percent of sampled health facilities offered TB services. More than 80% of the hospitals and health centers
offered TB services across the 26 districts. 46 percent of government or public health facilities offered TB services.
•Availability of trained staff to provide TB services was higher in hospitals (91 percent) than in health centers (81
percent).
•TB services offered between rural and urban health facilities were similar at 42 and 47 percent.

Malaria
•All (100 percent) facilities offered malaria diagnosis or treatment services across the 26 districts. Guidelines for
diagnosis and treatment were in 76 percent of health facilities
•Malaria rapid diagnostic test was the most common method for diagnosing malaria (98 percent) while microscopy
was offered in 28 percent of the health facilities
•Half (49 percent) of the health facilities had a first line antimalarial in stock, whereas 82 percent of health facilities
had SP for IPTp in stock

Non-Communicable Diseases
•Non communicable diseases assessed were diabetes, CVD, chronic respiratory and cervical cancer.
•Approximately one-third (31 percent) of the health facilities assessed offered diagnosis and or management of
diabetes.
•Diabetes diagnostic capacity comprising of urine dipstick for protein, urine dipstick for ketones and blood glucose
was available in 60 percent or more of all the health facilities.
•CVD diagnosis and management was offered in 48 percent of the health facilities, mostly in hospitals (86 percent)
and health centers (81 percent).
•The overall mean availability index for tracer items for CVD diagnosis and management was 43 percent.
•One-third (34 percent) of the facilities assessed offered chronic respiratory disease services.
•Mean availability index for tracer items for chronic respiratory disease diagnosis and management was 42 percent.
•Eleven percent of surveyed health facilities offered diagnosis of cervical cancer. These services were mostly
available in hospitals (69 percent) which are probably managed by NGO/not-for-profit (20 percent) or private for
profit (23 percent) health facilities.
•The mean availability of tracer items for cervical cancer services was 71 percent.

Surgical services
•Basic surgical services were available in 72 percent of the health facilities assessed.
•The most commonly available surgical services were incision and drainage of abscesses (71 percent), suturing (72
percent), wound debridement (72 percent) and acute burn management (65 percent).
•The mean availability of tracer items for basic surgical services was 39 percent.
•Staff and guidelines were the least available tracer items for surgical services. Only 6 percent of health facilities
reported to have integrated management for emergency and essential surgical care (IMEESC) guidelines and at least
one staff trained on IMEESC.
•Availability of medicines and commodities was high above 80 percent except for ketamine injectable (10 percent),
materials for cast (12 percent) and splints for extremities (4 percent) which were mostly available in hospitals.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
Blood transfusion
•85% of survey hospitals offered blood transfusion services, whereas one in five (19 percent) health centers had blood
transfusion services.
•The readiness score to provide blood transfusion services was 65 percent.
•Four out of ten facilities that offered blood transfusion had guidelines available. Blood typing services was high (95
percent) and available in hospitals and health centers, whereas cross-match typing was available in slightly more than
half (54 percent) of health facilities.
•Two-thirds (68 percent) of health facilities had blood storage refrigerator.

Advanced diagnostics
•The mean availability of tracer items for advance diagnostic capacity was 50 percent for the 53 hospitals assessed.
•The lowest available advanced diagnostics in hospital setting was serum electrolytes (13%), which were all available
in urban settings.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
INTRODUCTION

6
Ensuring access to quality health services is one of the main functions of a health system. Sound information on the
supply and quality of health services is necessary for health systems management, monitoring and evaluation. Efforts
to achieve the Sustainable Development Goals (SDGs) and scale-up interventions for HIV/AIDS, tuberculosis, malaria,
safe motherhood, child health and non-communicable diseases have drawn attention to the need for strong country
monitoring of health services and their readiness to deliver key interventions. SDG 3 calls for countries to ensure
healthy lives and promote wellbeing for all at all ages. In order to increase the chances of success to attain SDG 3
targets 3.1 and 3.2 there need to strengthen supplies at basic health centers in order to improve the chances of success
of Tanzania Roadmap for accelerating the reduction of the maternal and neonatal mortality
The service availability and readiness assessment is an effective way of monitoring the attainment of the targets under
SDG 3 and for accountability to the commitment of Government of Tanzania in improving the lives of its people.
The service availability and readiness assessment (SARA) functions as a systematic tool to support annual verification
of data and service delivery at health facilities. It explores the ability of public, private and faith-based health facilities
to provide general and specific services at minimum standards. The goals of the survey is to provide evidence based
data on health system progress to inform the annual health sector review, identify gaps and weaknesses responsible
for sub-optimal service provision and intervention coverage that need to be addressed, provide a baseline for planning
and monitoring scale-up intervention for service delivery improvement.
The service availability and readiness assessment tool generates a set of core indicators on key inputs and outputs of
the health system, which are used to measure progress in health system strengthening over time. Tracer indicators are
calculated to provide objective information about whether or not a facility meets the required conditions to support
provision of basic or specific services with a consistent level of quality and quantity. Summary or composite indicators
are provided to summarize and communicate information about multiple indicators and domains of indicators. Indices
are presented to describe the general and service-specific availability and readiness.
The three focus areas of SARA survey are;
Service availability refers to the physical presence of the delivery of services and encompasses health
infrastructure, core health personnel and aspects of service utilization.
General service readiness refers to the overall capacity of health facilities to provide general health
services. Readiness is defined as the availability of components required to provide services, such as
basic amenities, basic equipment, and standard precautions for infection prevention, diagnostic
capacity and essential medicines.
Service-specific readiness refers to the ability of health facilities to offer a specific service, and the
capacity to provide that service measured through consideration of tracer items that include trained
staff, guidelines, equipment, diagnostic capacity, and medicines and commodities.
The key topic areas and core functional capacities assessed in this survey include:
Identification, location and managing authority of health facility (public and private).
General facility status (e.g. availability of water supply, telecommunications, electricity, beds, etc.).
Basic medical equipment, such as X-ray, oxygen, weighing machines, etc.
Availability of health workforce (e.g. cadre of human resources, staff training and guidelines).
Drugs and commodities - availability of general medicines.
Diagnostic facilities: availability of lab tests (e.g. HIV, malaria, TB, others). Standard precautions:
availability of injection, sterilization, disposal, and hygiene practices.
Specialized services, such as for maternal and newborn child health, family planning, child and adoles
cent health, communicable diseases (e.g. HIV, TB, malaria), non-communicable diseases (diabetes,
cardiovascular, etc…).
Standard and specialized surgery services and blood transfusion

The report describes the availability of health care services, systems and practices for offering these services. Where
appropriate, methods of analysis, key assumptions and justifications, and key limitations are discussed under each
section.

2
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
METHODOLOGY AND
DATA COLLECTION

7
7.1 PLANNING PROCESS

The planning for SARA 2017 started in August 2017 with meetings between the Ministry of Health Community
Development Gender, Elderly and Children (MOHCDGEC), Ifakara Health Institute (IHI), Muhimbili University of Health
and Allied Sciences (MUHAS) and Khulisa Management Services. The meetings included discussing progress on
planning for adaptation of the SARA tools to the Tanzanian context, sample size and selection of health facilities,
pre-testing and thereafter pilot testing of the tools, conversion of the paper tools into Android Tablet PC, recruitment
and training of data collectors.

7.2 SELECTION OF HEALTH FACILITIES

The master facility list available on the MOHCDGEC health facility portal (http://hfrportal.ehealth.go.tz/, downloaded
in September 2017) was used to provide the sampling frame from which health facilities for this survey were sampled.
Health laboratories, specialized, national and zonal hospitals were excluded from the sample as they do not follow the
national health management reporting system. The master facility list used as a sampling frame had 7339 health
facilities (258-hospitals, 788 health centers and 6273 dispensaries). Health facility was considered as urban if it was
located in municipal or town council and rural otherwise. The study employs two stage sampling design. The first stage
involved random sampling of one district from each region of the mainland Tanzania. To attain the required sample
size, districts were sampled instead of councils as some of the councils had very few facilities.
The second stage involved random sampling of health facilities within each of the selected districts. All hospitals and
health centers found in each of the selected districts were included in the sample. Hospitals were included as per
SARA implementation guideline (booster sample) while the number of health centers found in selected districts was
lower than what was required in the sample size calculation. The final sample of health facilities included all hospitals
and health centers in the selected districts plus a simple random sample of the lower-level facilities stratified by a
combination of facility type, managing authority, and urban-rural distribution. The final selected sample had 592
facilities, a bit lower than the required sample size of 605 (including 10% non-response). This was because the selected
districts had fewer hospitals and health centers than what was assumed in the original sample size calculations.

7.3 SAMPLE AND SAMPLE WEIGHTS

General service availability was used as the main indicator for sample size calculation (p=0.5) from the service
provision assessment (SPA) results. Sample size calculations assumed a marginal error of 0.15, 95% CI and design
effect of 1.2. Sample size was calculated separately for each domain of interest. The total sample was then obtained
by taking the sum of the domain samples. The domains included in sample size calculation are facility ownership, facili-
ty type and rural/urban. Sample weights were calculated as the reciprocal of the product of the probability of
selecting the district from each region with that of selected health facilities from each of the sampled districts.

7.4 DATA COLLECTION AND ANALYSIS

Training
A team of 62 field interviewers and supervisors comprising of staff from the sampled districts and experience field
interviewers from IHI were convened in Dar es Salaam and trained for four days from the 25th-30th September 2017.
The training included one day where the tools were pilot-tested in selected health facilities in three municipals of Ilala,
Temeke and Kinondoni. The training aimed to provide an overview of survey, sampling methodology, interview skills,
roles, and responsibility of each partner and to orient data collection team to administer the tools. In addition, the
training provided the opportunity to adapt SARA tools to reflect what was actual on the ground. The training was
jointly facilitated by a team from IHI, MOHCDGEC and Khulisa.

4
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
Data collection
SARA tools were pre-programmed using open data kit (ODK) and installed in Tablet PCs. Range and consistency
checks were integrated in the pre-program questionnaire. We pre-loaded, the list of all selected facilities in order to
minimize data entry errors. Each field interviewer was assigned a unique identifier that was used to log him/her into
the SARA application. Each day field interviewers uploaded data to a central server located at IHI which allowed addi-
tional data quality checks and immediate feedback to the field team. Data collection was done in three weeks from
27/09/2017 to 13/10/2017.

Field supervision
Supervisory activities were designed to ensure accurate data collection and adherence to ethical standards.
Supervisors accompanied enumerators to the field and in some instances re-visited health facilities to correct or verify
information collected by the enumerator. The field coordinator managed daily logistics, such as preparation of
materials, while a statistician/IT Coordinator checked the quality of incoming data and addressed all inconsistencies
on a daily basis. Each team had daily meetings in the evening to review the day’s work, discuss challenges, and plan
for the next day.

Validity and reliability

To ensure validity and reliability, relevant experts from MOHCDGEC reviewed the tool prior to data collection, and
helped with translation to Kiswahili and a back translation to English to ensure the meaning was maintained. Prior to
the interviews, the survey team went through each element of the questionnaire to check the contents and consisten-
cy of questions. Enumerators were given a manual with descriptions and explanation of each question and medical
items. The team from Khulisa revisited a small sample of selected health facilities and re-interviewed the staff and
checked for availability and readiness to deliver health services. The two datasets were compared for quality control
as well as for feedback to the field team for improvement.

Data analysis
Data cleaning and analysis was performed using STATA version 14 software (Stata Corp, College Station, TX, USA) for
Windows adjusting for the survey design. The SARA WHO data analysis protocol was adapted while doing the analysis
with general results for each module presented followed with aggregated results by facility type, managing authority,
and residence of the health facility (rural/urban).

Data limitations
It is worth noting that the figures in this report are estimates based on data collected from a small fraction of the
health facilities in Tanzania. The distribution of health facilities by managing authority might have underestimated the
national estimates for some of the types due to fewer facilities that were found in the selected districts for that
category. During the data collection, field interviewers were supposed to observe each item asked in the
questionnaire. There were situations when interviewers would ask the respondent about all items and observe them
at the end of the interview as the equipment were located at a different location but within the facility settings. This
might have over or under estimated the availability of some equipment at the health facility.

5
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
SERVICE
AVAILABILITY

8
8.1 DISTRIBUTION OF FACILITIES

This section provides an overview of the composition of the final sample of health facilities, stratified by facility type
(level), managing authority and residence (urban/rural). 592 health facilities were sampled from 26 districts as shown
in Table 8.1. Out of all sampled facilities, 549 health facilities were interviewed giving a response rate of 92.7 percent.
Majority of non-interviewed health facility were in Dar es Salaam (66.7 percent) and Kagera (11 percent) region
respectively. Nine out of ten non-interviewed facilities were dispensaries. The most common reasons for not
interviewing these facilities were related with permission to access them especially the military owned health facilities,
permanently closed facilities andhard to reach facilities. Forty-four percent of health facilities selected were owned
and operated by government with 51 percent of these being dispensaries. Private for profit facilities made up 28
percent of the sample (18 hospitals, 18 health centers and 130 clinics/dispensaries). Faith-based plus other
not-for-profit facilities accounted for 163 facilities (27 percent of the sample), including 113 dispensaries, 28 health
centers and 22 hospitals.

BACKGROUND CHARACTERISTICS HOSPITAL HEALTH CENTERS DISPENSARIES

n n n

Managing authority

Government/public 20 102 124

NGO/not-for-profit 1 0 5
Private-for-profit 17 18 125
Mission/faith based 22 28 113
Parastatal 2 4 16

Urban/Rural

Rural 31 108 200

Urban 31 44 83

Total Sampled 62 152 384

Total Interviewed 53 152 344

response Rate 85.5 100 90.0

NOTES: n –SAMPLED FACILITIES

TABLE 8.1
Distribution of sampled and interviewed health facilities
by facility type managing authority and location of the health facility

7
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
TABLE 8.2

Shows the distribution of all facilities (N) and sampled facilities by facility type from each of the selected district. All
hospitals and health centers were included in the sample with total sample comprising of 62(10 percent) hospitals, 147
(25 percent) health centers and 383 (65 percent) dispensaries.

NAME OF THE DISTRICT HOSPITAL HEALTH CENTRE DISPENSARIES

N n N n N n

MONDULI 1 1 2 2 38 6
KINONDONI 25 25 28 28 185 103
DODOMA DISTRICT 3 3 11 11 53 28
CHATO 1 1 4 4 32 8
MUFINDI 1 1 8 8 56 9
MULEBA 3 3 5 5 39 15
MPANDA 1 1 6 6 32 12
BUHIGWE 1 1 4 4 29 5
MWANGA 1 1 7 7 48 7
LINDI DISTRICT 2 2 7 7 56 13
MBULU 2 2 3 3 37 16
BUTIAMA 1 1 1 1 37 9
RUNGWE 3 3 5 5 61 13
KILOSA 3 3 7 7 56 17
MTWARA DISTRICT 1 1 5 5 42 15
MAGU 1 1 3 3 32 4
LUDEWA 2 2 6 6 53 11
KISARAWE 1 1 3 3 32 4
NKASI 1 1 7 7 46 7
TUNDURU 2 2 4 4 52 11
KISHAPU 2 2 4 4 52 11
BUSEGA 1 1 2 2 24 5
IRAMBA 1 1 3 3 38 7
MOMBA 0 0 6 6 36 6
KALIUA 0 0 3 3 37 5
LUSHOTO 2 2 8 8 67 15
TOTAL 62 62 152 152 1270 383

Notes: N= Total number of facilities in the district, n= Number of sampled facilities,

TABLE 8.2
Distribution of health facilities in each of sampled district by facility type

8
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 personnel per 10,000
Generalist medical

Generalist medical
doctors- part time

doctors- part time

Specialist medical

Specialist medical

population (1),(2)
Non-physician
Background characteristic

professionals

professionals

Core health
Population

Midwifery
clinicians

Nursing
doctors

doctors
Level of service
Hospital 9,978,149 325 101 29 54 485 2871 372 4.2
Health center 9,978,149 105 23 11 43 413 1157 166 1.9
Dispensary 9,978,149 36 4 22 12 448 754 142 1.4
Managing Authority
Government/Public 9,978,149 193 32 1 1 663 2580 396 3.9
Mission/Faith Based 9,978,149 16 6 3 6 87 246 44 0.4
NGO/Not for profit 9,978,149 164 76 48 93 291 824 179 1.7
Ownership 9,978,149 93 14 9 10 301 1127 61 1.6
Public/Govt 9,978,149 0 0 0 0 4 5 0 0.0
Location
Rural 9,978,149 153 17 12 5.5 681 2484 363 3.7
Urban 9,978,149 313 111 49 103.5 664 2298 317 3.9
Total 466 128 61 109 1345 4782 680 7.6

(1) Core health personnel include physicians, non-physician clinicians, nursing professionals, and midwifery
professionals. This includes part-time physicians who are given the value of 0.5 in the scoring.

(2) Figures exclude national, referral and specialist hospitals

TABLE 8.3
Density of core health care professionals per 10 000 population, according to level of service,
managing authority and location of the health facility

TABLE 8.3

Shows the number of clinical staff per 10,000 population, divided into specialized doctors, general medical doctors,
non-physician clinician (AMO, CO, ACO) and nursing/midwifery professionals. Overall, there were 7.6 health
professionals per 10,000 population. This figure is an underestimate of the actual total because the final sample of
health facilities visited (549) was less than the total number of facilities on the master facility list (1484) for the
sampled districts, whereas the population denominator represents the entire population of the sampled districts.
The distribution of health care providers in rural 3,716 (49.1 percent) and urban 3,856 (50.9 percent) facilities were very
similar. As with regards to the composition of the professional health workforce of 7,571 in our sample, 764 (10
percent) were medical doctors (counting part-time medical personnel as 0.5 person-equivalent), compared to 1,345
(18 percent) non-physician clinical staff and 4,782 (63 percent) nurses and 680 (9 percent) midwives. Government
health facilities accounted for 51 percent of health professionals, private non-mission/faith-based 21 percent and
private-for-profit facilities 22 percent.

9
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
8.2 FACILITY DENSITY

Facility density provides a simple summary measure of the availability of health care outlets (irrespective of ownership
or type). Table 8.4 shows health facility density for the full target sample of health facilities (i.e. all health facilities that
exist in the sampled districts in the master facility list, whether or not they were included in the final SARA sample).
For districts that have recently been split into two or more administrative councils such as Ubungo and Kinondoni,
data have combined from each child councils to form the district as it was captured in 2012 census. The full target
sample is used here because the final sample would otherwise under-represent facility density and variable response
rates across districts would skew the findings. The results illustrate a very wide range of facility density across districts,
ranging from a minimum of 0.7 facilities per 10,000 populations in Mwanga to 4.4 per 10,000 in Lushoto. It should be
noted that this measure does not take into account sparse population distribution. As a rule, more densely populated
areas tend to have fewer, busier health facilities while sparsely distributed districts have more facilities with lower
workloads. The mean number of health facilities per 10,000 populations was 1.87 facilities.

DISTRICT *POPULATION [2017] NUMBER OF HEALTH TOTAL NUMBER OF HEALTH

FACILITIES FACILITIES PER 10,000
POPULATION

BUHIGWE 223,220 34 1.52

BUSEGA 223,220 27 1.21
BUTIAMA 239,646 39 1.63
CHATO 416,368 37 0.89
DODOMA DISTRICT 456,035 67 1.47
IRAMBA 265,355 42 1.58
KALIUA 455,305 40 0.88
KILOSA 492,879 66 1.34
KINONDONI 2,351,346 238 1.01
KISARAWE 113,199 36 3.18
KISHAPU 302,589 58 1.92
LINDI DISTRICT 286,021 65 2.27
LUDEWA 138,618 61 4.40
LUSHOTO 371,662 77 2.07
MAGU 375,352 36 0.96
MBULU 224,101 42 1.87
MOMBA 198,269 42 2.12
MONDULI 182,275 41 2.25
MPANDA 380,544 39 1.02
MTWARA DISTRICT 245,889 48 1.95
MUFINDI 260,435 65 2.50
MULEBA 632,898 47 0.74
MWANGA 143,466 56 3.90
NKASI 330,078 54 1.64
RUNGWE 274,189 69 2.52
TUNDURU 331,654 58 1.75
TOTAL 9,978,149 1484 1.87

*Projected from 2012 census[http://www.nbs.go.tz/]

TABLE 8.4
Number of health facilities per 10,000 population

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
GENERAL SERVICE
READINESS

9
General Service Readiness refers to the overall capacity of the health facilities to provide general health services based
on the availability of infrastructure, basic amenities and equipment, standard precautions for infection control,
diagnostic tests, medicines and commodities.

9.1 BASIC AMENITIES

Providing an enabling working environment is critical for effective and functional health care delivery system. Such
enabling environment comprises the physical infrastructure and the availability of basic equipment and resources for
delivering quality services. Basic amenities were assessed in the 26 districts based on the availability of the following
tracer items: power (grid or generator), communication equipment, improved water source, adequate sanitation
facilities, and computer with internet access, and emergency transportation. Figure 9.1 shows percentage availability
of basic amenities and infrastructure at health facilities in the 26 districts.

Sanitation facilities 68%

Communication equipment 52%

Improved water source 58%

Emergency transport 10%

Consultation room 71%

Power source 74%

Computer with internet 15%

Percent of facilities with all items 4%

Mean availability of tracer items 50%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percentage availability

FIGURE 9.1
Percentage of facilities with basic amenities items available

•On average, facilities had 3 of 7 tracer items, for an average basic amenities readiness score of 50 out of 100
•Three quarters of the facilities had a source of power (electricity grid, functional generator with fuel or solar) on the
day of the assessment. The availability ranged from 71 percent in government hospital to 100 percent in parastatal
facilities. There were no disparities between urban and rural facilities in the availability of power.
•Two thirds of the facilities had sanitation facilities. While 58 percent had an improved water source on the facility
grounds or within 500m of the facility
•15 percent of the facilities had a computer with internet. Hospitals were more likely to have a computer with internet
compared to other levels of care.
•Only 1 in 10 facilities had emergency transport. Hospitals and health centers were more likely to have emergency
transport compared to dispensaries

12
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 9.2 BASIC EQUIPMENT

We assessed health facilities to have basic equipment by asking as to whether they had the following items; adult
scale, infant scale, stethoscope, thermometer, blood pressure apparatus, and a light source for patient examinations.

Figure 9.2 below shows that

•On average, facilities had 5 of 6 tracer items, for a mean basic equipment readiness score of 82 out of 100.
•Five of the six basic items were available in 80 percent of more facilities. Stethoscope, adult scales
and thermometers were available in 94 percent, 92 percent and 91 percent of the facilities respectively.
•Light source that could be used for patient examination was the least available item among the six basic
items. Less than half (47 percent) of the facilities had this item on the day of assessment.

Blood pressure apparatus 89%

Stethoscope 94%

Thermometer 91%

Adult scale 92%

Child scale 79%

Light source 47%

Percent of facilities with all items 32%

Mean availability of tracer items 82%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 9.2
Percentage of facilities with basic equipment available (N=549)

9.3 STANDARD PRECAUTIONS FOR INFECTION CONTROL

The availability of systems or practices to ensure the safety of staff and service users was assessed based on the
reported presence of the following nine items:
•Safe final disposal of sharps
•Safe final disposal of infectious waste
•Appropriate storage of sharps waste
•Appropriate storage of infectious waste
•Disinfectant
•Single use – standard disposable or auto-disable syringes
•Soap and running water or alcohol based hand rub
•Latex gloves
•Guidelines for standard precautions

13
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
FIGURE 9.3

shows the availability of systems and practices for ensuring safety of staff and service users. Of the nine systems and
practices that were inquired about during the assessment, only 9 percent of the health facilities reported the
availability of all of them. Hospitals reported having 29 percent of the nine tracer items assessed for standard
precautions for infection prevention, Health centers reported 14 percent and dispensaries reported 7 percent. On
average, health facilities reported the availability of approximately two thirds (65 percent) of the standard precautions
for infection prevention. Disposable or auto disables syringes and disinfectant were available in all hospitals and health
centers. Availability of guidelines for standard precaution ranges from 41 percent in dispensaries to 77 percent in
hospitals. The lowest available trace item was a safe final disposal of infectious waste (30 percent) which varied from
28 percent in dispensaries to 49 percent in hospitals.

Disposable or auto disable syringes 100%

Disinfectant 96%
Appropriate storage of sharps waste 69%
Safe final disposal of infectious waste 30%
Latex gloves 68%
Safe final disposal of sharps 51%
Soap and water OR alcohol based hand rub 60%
Appropriate storage of infectious waste 62%
Guidelines for standard precautions 45%
Percent of facilities with all items 9%
Mean availability of tracer items 65%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 9.3
Percentage of facilities with standard precaution for infection control items available

9.4 DIAGNOSTIC CAPACITY

Diagnostic capacity of health facilities is a key component in health services delivery. Having quality diagnostic
services at all levels of health care provides the opportunity of health facilities to provide good care to clients.
Facilities for SARA 2017 in Tanzania were assessed on the capacity to conduct the following diagnostic tests on-site:
HIV test (RDT or ELISA), blood glucose test, malaria test (RDT or smear), syphilis rapid test (VDRL/RPR),
haemoglobin test, urine pregnancy test, urine dipstick for protein, urine dipstick for glucose, urine glucose dipstick
test measures the levels of ketones to diagnose or monitor Type I diabetes.
Figure 9.4 shows the mean availability of diagnostic test in health facilities was found to be just above half (52%).
Diagnostic capacity for HIV and malaria was high at 98% and 93% respectively. A quarter (26%) of the health facilities
reported to have capacity to conduct blood glucose tests, while approximately one third reported to have capacity to
conduct urine dipstick for protein (31%) and haemoglobin (33%). Only one in ten facilities reported to have capacity
for all the diagnostic tests on the day of the survey.

14
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 HIV diagnostic capacity 93%
Malaria diagnostic capacity 98%
Urine test for pregnancy 50%
Urine dipstick- protein 31%
Urine dipstick- glucose 29%
Syphilis rapid test 58%
Haemoglobin 33%
Blood glucose 26%
Percent of facilities with all items 10%
Mean availability of tracer items 52%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 9.4
Percentage of facilities with diagnostic items available

9.5 ESSENTIAL MEDICINES

In order to provide adequate services, health facilities need to be well stocked with essential medicines. The
essential medicines domain consists of tracer items on 14 essential medicines including medicines for acute

Ampicillin injection 32%

Ceftriaxone injection 79%
Amoxicillin tablet 89%
Amlodipine tablet or alternative calcium channel blocker 23%
Amoxicillin syrup/suspension/ dispersible tablet 61%
Aspirin cap/tab 65%
Beclometasone inhaler 3%
Beta blocker 14%
Carbamzepine tablet 3%
Enalapril tablet or alternative ACE inhibitor 6%
Fluoxetine tablet 1%
Gentamicin injection 68%
Haloperidol tablet 3%
Insulin regular injection 6%
Magnesium sulphate injectable 73%
Metformin tablet 19%
Oral rehydration solution 90%
Oxytocin injection 83%
Thiazide 7%
Zinc sulphate tablet or syrup 67%
Salbutamol inhaler 24%
Glibenclamide tablet 15%
Omeprazole tablet or alternative 35%
Simvastatin tablet or other statin 5%
Percent of facilities with all items 0%
Mean availability of tracer items 38%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 9.5
Percentage of facilities with essential medicines items available

15
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
infectious diseases, pain relief, and non-communicable diseases: Ampicillin injection, Amoxicillin tablet, Amoxicillin
syrup or suspension, Beclometasone inhaler, Carbamazepine, Fluoxetine, Haloperidol, Magnesium Sulphate injectable,
Oral Rehydration Salt (ORS), Thiazide, Salbutamol inhaler, and Omeprazole tablets. It should be noted that not all
health facilities stock all of essential medicines in the list above. Hospitals and health centers are expected to stock
the above list of times.
Figure 9.5 shows the percentage of facilities with essential medicines. Of the 24 essential medicines, none of the
facilities reported to have all of the essential medicines. On average, facilities reported to have only 38 percent of the
essential medicines. Most common essential medicine found in health facilities during the survey included ORS (90
percent), Amoxicillin tablets (89 percent), Oxytocin injection (83 percent), Ceftriaxone (79 percent) and magnesium
Sulphate injectable (73 percent). Essential medicines that were found to be mostly out of stock in health facilities
during the survey included, Fluoxetine tablets (1 percent), Carbamazepine (3 percent), Beclometasone inhaler
(3 percent), Haloperidol tablets (3 percent), Enalapril or alternative ACE inhibitor (6 percent).
essential medicines. Most common essential medicine found in health facilities during the survey included ORS (90
percent), Amoxicillin tablets (89 percent), Oxytocin injection (83 percent), Ceftriaxone (79 percent) and magnesium
sulphate injectable (73 percent). Essential medicines that were found to be mostly out of stock in health facilities
during the survey included, Fluoxetine tablets (1 percent), Carbamazepine (3 percent), Beclometasone inhaler
(3 percent), Haloperidol tablets (3 percent), Enalapril or alternative ACE inhibitor (6 percent).

9.6 GENERAL SERVICE READINESS

The general service readiness index is a composite measure that combine information from the five general service
readiness domains: basic amenities, basic equipment, standard precautions, laboratory diagnostics, and medicines.
The index is a useful measure that summarizes the situation of health services. The general service readiness index
score for the facilities covered in the 2017 SARA is 57 out of 100 (Figure 9.6). The GSR for facilities surveyed in the
SARA 2012 was 42 out of 100. Across the five domains, the basic equipment and standard precautions mean scores
were the highest, diagnostics and basic amenities mean scores were moderate, while essential medicine score was the
lowest.

*((#$
,(#$ &'#$
&(#$
%!#$
"(#$
!"#$
%(#$ !(#$ !'#$
Index

!(#$
)&#$
+(#$
)(#$
'(#$
*(#$
(#$
!"#"$%&' ("$)*+"' ./%#,%$,' 4%(*+' 4%(*+'%3"#*/*"(' 6*%7#2(/*+(' 8(("#/*%&'
$"%,*#"(('*#,"- 0$"+%1/*2#(' "51*03"#/' 3"%#' (+2$" 3"%#' (+2$" 3",*+*#"('
3"%#' (+2$" 3"%#' (+2$" 3"%#' (+2$"

FIGURE 9.6
General service readiness index and domain scores

16
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
SERVICE SPECIFIC
AVAILABILITY AND
READINESS

10
In addition to assessing the general service readiness of facilities, the SARA measured the availability and readiness
of health facilities to offer specific health interventions using a list of tracer items that include trained staff,
guidelines, equipment, diagnostic capacity, and medicines and commodities. The following key health services were
measured in the SARA 2017.

Maternal, neonatal and child health

• Family planning
• Antenatal care
• Prevention of mother-to-child transmission of HIV
• Obstetric and newborn care
• Comprehensive obstetric care
• Immunization

Child and Adolescent Health

• Child preventative and curative care

• Adolescent reproductive health services

Communicable Diseases

• HIV counselling and testing

• HIV treatment
• HIV care and support
• Sexually transmitted infections
• Tuberculosis
• Malaria

Non-Communicable Diseases

Surgery

Blood transfusion

Diagnostics

18
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
MATERNAL,
NEWBORN AND
CHILD HEALTH

11
The Ministry of Health Community Development Gender Elderly and Children (MOHCDGEC) health sector strategic
plan IV (HSSP IV)1 emphasizes that reproductive, maternal, newborn, child and adolescent Health (RMNCAH) will
continue to be a priority area for Tanzania to achieve the Sustainable Development Goals (SDG)2 in 2030. Tanzania is
one of the countries with the highest maternal mortality ratio (MMR) in the region. In the 2015/16 Tanzania
Demographic and Health Survey (TDHS)3, MMR was reported to be 556 deaths per 100,000 live births.

The Tanzania Ministry of Health Community Development Gender Elderly and Children, however, has made significant
progress in improving child survival. Under five mortality declined from 81 deaths per 1000 livebirths in 2010 to 61
deaths per 1000 live birth in 2015/16. On the other hand, progress on newborn survival has stagnated with neonatal
mortality rate of 24 deaths per 1000 live births.

Through the big results now (BRN)4, the ministry has identified maternal and newborn health as one of the key result
areas (KRAs) and has prioritized interventions in regions with high mortality and morbidity, It will require concerted
efforts by all key stakeholders if Tanzania is to achieve the SDG target of 8 deaths per 1000 live births for newborns
and 145 per 100,000 livebirths for maternal deaths.

11.1 FAMILY PLANNING

Family planning (FP) services consist of educational, comprehensive medical, or social activities which enable
individuals to determine freely the number and spacing of their children and to select the means by which this may
be achieved. The current contraceptive prevalence rate among married women (15-49) is 32 percent. The HSSP IV
target is to increase this to 60 percent by 2020. Overall, 38 percent percent of currently married women are using any
method of family planning.

SERVICE AVAILABILITY

Figure 11.1 shows the percent availability of family planning services. 86 percent of the facilities visited reported to
offer family planning services. Most common services that were found to be available were male condoms (81
percent), combined oral contraceptive (76 percent) and progestin-only injectable (75 percent). In contrast, only one
quarter of the health facilities had female condoms available and none had combined injectable contraceptives. Male
(4 percent) and female sterilization (9 percent) were less commonly offered family planning services.
Government health facilities had almost universal availability of FP services (99 percent) while less than half (46
percent) of mission or faith based health facilities provided family planning services as shown in Table 11.1. Male
condoms were found to be more available in rural compare to urban facilities 84 percent versus 74 percent whereas
female condoms were more available in urban facilities than rural facilities 30 percent versus 23 percent.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Offers family planning services 86%
Combined oral contraceptives 76%
Progestin-only injectable contraceptives 75%
Cycle beads for standard days method 26%
Male condoms 81%
Implant 62%
Combined injectable contraceptives 0%
Progestin-only contraceptives 55%
Female condoms 25%
IUCD 33%
Emergency contraceptive pills 52%
Female sterilization 9%
Male sterilization 4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 11.1
Percentage of facilities that offer family planning services (N=549)

SERVICE READINESS

Health facilities offering family planning services (549 facilities total) were also assessed on their readiness to
provide the service based on the availability of the six tracer items; availability of family planning guidelines, at least
one staff trained on FP, family planning check-list and or guidelines (staff and guidelines), blood pressure apparatus
(equipment), Combined estrogen progesterone oral contraceptive pills, Progestin-only contraceptive pills,
Injectable contraceptives and condoms (medicines and commodities). 375 health facilities had tracer items for
family planning services on day of the survey among facilities that offer this service.

21
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 22
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 CONTRACEPTIVES

CONTRACEPTIVES

CONTRACEPTIVES

CONTRACEPTIVES

CONTRACEPTIVES
PROGESTIN-ONLY

PROGESTIN-ONLY

PROGESTIN-ONLY

PROGESTIN-ONLY
OFFERS FAMILY

OFFERS FAMILY
COMBINED ORAL

COMBINED ORAL

CONTRACEP

CONTRACEP
INJECTABLE

INJECTABLE

INJECTABLE
PLANNING

PLANNING
SERVICES

SERVICES

COMBINED

COMBINED

CONDOMS
TIVES

TIVES
MALE
Facility type Facility type
Hospital Hospital91% 78% 91% 68% 78% 0% 68% 70% 0% 78% 70%
Health centre Health centre
80% 71% 80% 64% 71% 0% 64% 72% 0% 76% 72%
Dispensary Dispensary
86% 76% 86% 54% 76% 0% 54% 76% 0% 81% 76%
Managing authority Managing authority
Government/public Government/public
99% 89% 99% 65% 89% 0% 65% 90% 0% 96% 90%
NGO/not-for-profit NGO/not-for-profit
72% 58% 72% 54% 58% 0% 54% 58% 0% 58% 58%
Private-for-profit Private-for-profit
37% 33% 37% 24% 33% 0% 24% 22% 0% 30% 22%
Mission/faith based Mission/faith
46% based 30% 46% 22% 30% 0% 22% 31% 0% 33% 31%
Parastatal Parastatal
68% 68% 68% 0% 68% 0% 0% 68% 0% 68% 68%
Urban/Rural Urban/Rural
Rural Rural 89% 78% 89% 58% 78% 0% 58% 79% 0% 84% 79%
Urban Urban 76% 70% 76% 47% 70% 0% 47% 66% 0% 70% 66%
Total Total 86% 76% 86% 55% 76% 0% 55% 75% 0% 81% 75%

TABLE 11.1
Percentage of facilities with family planning items available (N=549)

TABLE 11.1
Percentage of facilities with family planning items available (N=549)

23
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 CYCLE BEADS FOR

CYCLE BEADS FOR

CONTRACEPTIVE

CONTRACEPTIVE
STANDARD DAYS

STANDARD DAYS

TOTAL NUMBER

TOTAL NUMBER
STERILIZATION

STERILIZATION

STERILIZATION

STERILIZATION
OF FACILITIES

OF FACILITIES
EMERGENCY

EMERGENCY
CONDOMS

IMPLANT

IMPLANT
METHOD

METHOD
FEMALE

FEMALE

FEMALE
MALE

MALE
PILLS

PILLS
IUCD

52% 76% 71% 54% 76% 69% 54% 42% 69% 67% 42% 53 67% 53
37% 75% 65% 36% 75% 60% 36% 12% 60% 26% 12% 152 26% 152
22% 59% 27% 24% 59% 50% 24% 1% 50% 4% 1% 344 4% 344

29% 72% 35% 27% 72% 60% 27% 3% 60% 8% 3% 254 8% 254
9% 54% 54% 60% 54% 55% 60% 14% 55% 18% 14% 17 18% 17
12% 28% 29% 15% 28% 17% 15% 8% 17% 12% 8% 126 12% 126
15% 27% 19% 22% 27% 25% 22% 4% 25% 9% 4% 149 9% 149
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3 0% 3

23% 62% 32% 25% 62% 51% 25% 3% 51% 8% 3% 328 8% 328
30% 60% 35% 29% 60% 53% 29% 5% 53% 12% 5% 221 12% 221
25% 62% 33% 26% 62% 52% 26% 4% 52% 9% 4% 549 9% 549

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 11.2 ANTENATAL CARE

Antenatal care (ANC) is important to monitor pregnancy and for optimal health outcomes for the mother and infant
during pregnancy, at delivery and during postnatal period. Health facilities at various levels of health care are
mandated to offer ANC services. The national policy indicates that all pregnant women are to attend ANC at least
four times before they deliver. This is to ensure the safety of both the mother and child. The 2015-16 TDHS-MIS3
results show that almost all women (98 percent) who gave birth in the 5 years preceding the survey received ante-
natal care from a skilled provider at least once for their last birth. However, only half of the women had four or more
ANC visits as required by the policy.

SERVICE AVAILABILITY

Figure 11.2 shows that almost 9 out 10 health facilities assessed provided ANC services. The provision of
Sulphadoxine Pyremethamin (SP) to prevent malaria during pregnancy was 87%. Estimates from the 2015-16
TDHS-MIS shows that despite the availability of this service in most health facilities, two thirds (68 percent) of
pregnant women took one or more dose of SP during pregnancy and only 35% of pregnant women were classified
at having received the recommended dose (2 more doses) of IPTp. 83 percent of the facilities provided monitoring
of hypertensive disorders of pregnancy and tetanus toxoid vaccination. These are key interventions to detect
indications of preterm birth and for the prevention neonatal tetanus respectively. Two thirds of the facilities
assessed in SARA 2017 reported to provide iron and folic acid supplementation

Offers antenatal care 89%

IPTP 87%

Monitoring for hypertensive disorder of pregnancy 83%

Tetanus toxoid vaccination 83%

Iron supplementation 66%

Folic acid supplementation 67%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 11.2
Percentage of facilities that offer antenatal services (N=549)

SERVICE READINESS

Tracer items required for the provision of antenatal care services assessed included: guidelines on antenatal care
services and staff trained in ANC in the past two years (staff and guidelines), blood pressure apparatus (equipment),
hhaemoglobin and urine-dipstick-protein (diagnostics), iron tablets, folic acid tablets and tetanus toxoid vaccine
(medicines and commodities).
The mean availability of tracer items for ANC services was 62 out 100. 430 out of the 459 heath facilities assessed
were ready to provide ANC services. IPTp drug (90 percent), blood pressure equipment (88 percent) and tetanus
toxoid vaccine (85 percent) were mostly available items.

25
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
Half (51 percent) of the health facilities were able to show ANC guidelines during assessment. Hospitals had (63
percent) and health centers (61 percent) whereas almost half (49 percent) of the dispensaries had guidelines
available. Less than half (46 percent) of the health facilities had at least one of the staff trained on ANC. 44% of the
dispensaries and 65% of health centers where most of these services are provided, reported to have at least one staff
trained on ANC.

Table 11.3 shows the readiness to provide diagnostic tests required during pregnancy was low. Overall one out of three
(31 percent) were ready to provide a haemoglobin test, whereas 27 percent of the facilities were ready to provide a
urine dipstick protein test. Hospitals were more prepared to provide haemoglobin (87 percent) and urine dipstick for
protein (85 percent) tests as compared to health centers (79 percent and 72 percent) and dispensaries (22 percent
and 18 percent). Urban health facilities were more ready to provide these diagnostic services compared to rural health
facilities. For haemoglobin test urban had 47 percent of the facilities ready as compared to 26 percent of rural health
facilities, similarly half of the health facilities in urban areas were ready to provide urine dipstick for protein test
compared to 20 percent of rural health facilities.

One out of three (31 percent) of the health facilities reported readiness to provide insecticide treated nets (ITNs). This
is low because net distribution through ANC is no longer used as a strategy to ensure pregnant women received nets.
Since 2013 the national malaria control program (NMCP) has been distributing nets to pregnant women and children
through campaign and in schools.

hypertensive disorder
supplementation

supplementation
Offers antenatal

Total number of
Tetanus toxoid

Monitoring for

of pregnancy
vaccination
Folic acid

facilities
IPTP
care

Iron

Facility type
Hospital 95% 84% 85% 93% 95% 95% 53
Health center 93% 78% 78% 92% 91% 92% 152
Dispensary 88% 64% 65% 86% 81% 82% 344
Managing authority
Government/public 97% 71% 72% 95% 90% 90% 254
NGO/not-for-profit 85% 79% 81% 81% 85% 85% 17
Private-for-profit 39% 33% 35% 36% 37% 38% 126
Mission/faith based 80% 62% 61% 77% 77% 78% 149
Parastatal 68% 68% 68% 68% 68% 68% 3
Urban/Rural
Rural 92% 68% 70% 90% 85% 86% 328
Urban 79% 59% 60% 78% 78% 74% 221
Total 89% 66% 67% 87% 83% 83% 549

Table 11.2
Percentage of facilities that offer antenatal care services (N=549)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 AND/OR JOB-AIDS

AND/OR JOB-AIDS
ANTENATAL CARE

ANTENATAL CARE
BLOOD PRESSURE

BLOOD PRESSURE
ANC CHECK-LISTS

ANC CHECK-LISTS

URINE DIPSTICK
TRAINED STAFF

TRAINED STAFF

HAEMOGLOBIN

HAEMOGLOBIN
AT LEAST ONE

AT LEAST ONE

PROTEIN TEST
ANTENATAL

ANTENATAL
GUIDELINES

GUIDELINES
AVAILABLE

AVAILABLE

APPARATUS

APPARATUS
CARE

CARE

TEST
Facility type Facility type
Hospital Hospital63% 90% 63% 54% 90% 100% 54% 87% 100% 85% 87%
Health center Health center
61% 78% 61% 65% 78% 97% 65% 79% 97% 72% 79%
Dispensary Dispensary
49% 61% 49% 44% 61% 86% 44% 22% 86% 18% 22%
Managing authority Managing authority
Government/public Government/public
50% 65% 50% 45% 65% 87% 45% 25% 87% 20% 25%
NGO/not-for-profit NGO/not-for-profit
95% 96% 95% 35% 96% 100% 35% 47% 100% 56% 47%
Private-for-profit Private-for-profit
35% 38% 35% 59% 38% 98% 59% 57% 98% 72% 57%
Mission/faith based Mission/faith
50% based 64% 50% 51% 64% 95% 51% 64% 95% 57% 64%
Parastatal Parastatal
100% 60% 100% 100% 60% 60% 100% 60% 60% 100% 60%
Urban/Rural Urban/Rural
Rural Rural 48% 65% 48% 45% 65% 88% 45% 26% 88% 20% 26%
Urban Urban 60% 62% 60% 52% 62% 90% 52% 47% 90% 51% 47%
Total Total 51% 65% 51% 46% 65% 88% 46% 31% 88% 27% 31%

TABLE 11.3
Percentage of facilities that have tracer items for antenatal care services among facilities that provide ANC services
TABLE 11.3
Percentage of facilities that have tracer items for antenatal care services among facilities that prov

27
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 FOLIC ACID TABLETS

MEAN AVAILABILITY

MEAN AVAILABILITY
NUMBER OF

TOTAL NUMBER OF
OF TRACER ITEMS

OF TRACER ITEMS
TETANUS TOXOID

TETANUS TOXOID

FACILITIES WITH

FACILITIES WITH
IRON TABLETS

PERCENT OF

PERCENT OF

FACILITIES

FACILITIES
ALL ITEMS

ITEMS
IPT DRUG

IPT DRUG
VACCINE

VACCINE

TOTAL
ITNS

ITNS

ALL
92% 98% 94% 88% 98% 54% 88% 35% 54% 85% 35% 50 85% 50
80% 94% 88% 89% 94% 31% 89% 21% 31% 80% 21% 142 80% 142
63% 83% 72% 90% 83% 28% 90% 3% 28% 59% 3% 238 59% 238

64% 84% 73% 91% 84% 31% 91% 5% 31% 61% 5% 242 61% 242
91% 95% 95% 82% 95% 60% 82% 11% 60% 79% 11% 14 79% 14
89% 90% 95% 92% 90% 27% 92% 13% 27% 72% 13% 52 72% 52
67% 86% 76% 78% 86% 12% 78% 15% 12% 69% 15% 120 69% 120
% 100% 100% 100% 100% 100% 0% 100% 60% 0% 88% 60% 2 88% 2

61% 84% 70% 89% 84% 29% 89% 5% 29% 60% 5% 273 60% 273
84% 88% 92% 94% 88% 31% 94% 12% 31% 72% 12% 157 72% 157
66% 85% 75% 90% 85% 30% 90% 7% 30% 62% 7% 430 62% 430

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 11.3 PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV

The services related to preventing mother-to-child transmission (PMTCT) include counselling and testing for HIV+
pregnant women, counselling and testing for infants born to HIV+ women, ARV prophylaxis to HIV+ pregnant
women, ARV prophylaxis to infants born to HIV+ women, Infant and young child feeding counselling, nutritional
counselling for HIV+ women and their infants and family planning counselling to HIV+ women. The facilities that
offer PMTCT services were 84 percent (N=549). The specific services offered to HIV positive women are summa-
rized in Table 11.4 below:

Total
Offers services for PMTCT 84%
ARV prophylaxis to HIV+ women 81%
Family planning counselling to HIV+ women 82%
HIV counselling & testing to HIV+ pregnant women 83%
HIV counselling & testing to infants born to HIV+ pregnant women 78%
Infant & young child feeding counselling 83%
Nutritional counselling for HIV+ women & their infants 83%
ARV prophylaxis to newborns born to HIV+ pregnant women 77%

TABLE 11.4
Percentage of facilities offering PMCTC services (N=549)

In terms of facilities readiness, the mean availability for tracer items for PMTCT services was 62% (N=409) and none
of the facilities had all the items (Figure 11.3). The specific services staff and guidelines, equipment, diagnostics and
most of the medicines and commodities have very good levels.

Guidelines available PMTCT 72%

At least 1 trained staff PMTCT 63%

Guidelines infant and young child feeding 67%

At least 1 trained staff infant and young child feeding 52%

Room with visual and auditory privacy 68%

HIV diagnostic capacity for adults 98%

DBS for diagnosing newborn HIV 58%
Nevirapine syrup 65%
Maternal ARV prophylaxis 73%
Zidovudine syrup 1%
Mean availability of tracer items 62%
Percent of facilities with all items 0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Equipment Diagnostics Medicines and Commodities Readiness Score

FIGURE 11.3
Percentage of facilities that have tracer items for PMTCT among facilities that provide this services (n=409)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
11.4 OBSTETRIC AND NEWBORN CARE

The obstetric signal functions included delivery services, parenteral administration of antibiotics, oxytocic drug and
anticonvulsants as well as assisted vaginal delivery. Other services included manual removal of placenta and retained
products as well as neonatal resuscitation and the basic emergency obstetric care.

SERVICE AVAILABILITY

The results in Figure 11.4 show that the mean availability of obstetric signal functions offered was 59 percent (n=549).
While delivery services were offered at 81 percent of the health facilities, the specific services ranged between 66
percent and 57 percent.
The findings showed that health facilities had high levels around 80 percent in terms of availability of signal functions
for administration of oxytocins for prevention of postnatal hemorrhage, hygienic code care and use of partograph for
monitoring and managing labor.
For neonatal health, the signal functions availability was very low at mean level of 30 percent. Specifically, the level
availability of resuscitation was reasonable at 64% but there was low provision of corticosteroid in preterm labour
(15 percent) and injectable antibiotics for neonatal sepsis (17 percent).

Offers delivery services 81%

Assisted vaginal delivery 62%

Manual removal of placenta 58%

Parenteral administration of antibiotics 57%

Parenteral administration of anti-convulsants 52%

Manual removal of retained products 60%

Parenteral administration of oxytocic drugs 66%

Mean availability of obstetric signal functions offered 59%

Neonatal resuscitation 64%

Antibiotics for preterm or prolonged PROM 42%

Corticosteroids in preterm labour 14%

Injectable antibiotics for neonatal sepsis 17%

KMC for premature/very small babies 42%

Mean availability of newborn signal functions offered 30%

Administration of oxytocin for the prevention of post-partum 81%
haemorrhage
Hygienic cord care 81%

Immediate and exclusive breastfeeding 81%

Monitoring and management of labour using partograph 77%

Thermal protection 81%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 11.4
Percentage of facilities that offer basic obstetric care services (N=549)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

Figure 11.5 shows that facilities that had tracer items for basic obstetric care among facilities that provide delivery
services had a mean of 61 percent (n=375). The levels of medicines and commodities is very good mostly above 85
percent, staff capacity and guidelines are 50 percent or below with exception of job-aids for essential child care at
77 percent.
The levels of equipment and diagnostic is mixed. There were very low levels of emergency transport at 9 percent,
sterilization equipment at 39 percent; and good levels of gloves, partograph, and delivery pack were above 93
percent and blood pressure apparatus was 88 percent.

Guidelines for essential childbirth care 50%

At least one staff trained in essential childbirth care 44%

Check-lists and/or job-aids for essential childbirth care 77%

Staff trained in newborn resuscitation 43%

Guidelines for essential newborn care 46%

Delivery bed 14%

Delivery pack 94%

Partograph 93%

Gloves 99%

Emergency transport 9%

Sterilization equipment 39%

Suction apparatus 80%

Examination light 35%

Vacuum aspirator or D&C kit 12%

Neonatal bag and mask 56%

Manual vacuum extractor 12%

Blood pressure apparatus 88%

Infant weighting scale 92%

Soap and running water OR alcohol based hand rub 87%

Antibiotic eye ointment 63%

Injectable antibiotic 90%
Skin disinfectant 94%
Injectable uterotonic 94%
Magnesium sulphate (injectable) 85%
Intravenous solution with infusion set 89%
Mean availability of tracer items 61%
Percent of facilities with all items 0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Equipment Diagnostics Medicines and Commodities Readiness Score

FIGURE 11.5
Percentage of facilities that have tracer items for basic obstetric care among facilities
that provide delivery services (n=375)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
11.5 COMPREHENSIVE OBSTETRIC CARE

According to the TDHS-MIS 2015-2016, maternal mortality ratio (MMR) was 556 deaths per 100,000 live births. This
figure increased from 454 in 2010. Although the 95 percent confidence intervals for the 2010 TDHS and 2015/2016
TDHS-MIS MMR estimates overlap, the current estimates threaten Tanzania’s efforts to achieve SDG goal of reducing
maternal mortality by 70 per 100,000 deaths. The major causes of maternal deaths include obstetric haemorrhage,
obstructed labour, pregnancy induced hypertension, sepsis and abortion complications. Increasing access to high
quality emergency obstetric care is likely to reduce maternal and newborn mortality. Health facilities ought to have a
surgeon and anaesthetist with the necessary equipment and supplies order to manage obstetric complications
whenever occur.
Comprehensive emergency obstetric care (CEmOC) is generally offered at the district hospital level, and consists of
the 7 functions of basic emergency obstetric care plus Caesarean section and safe blood transfusion. Guidelines
jointly issued by WHO, UNICEF, and UNFPA recommend four health facilities offering basic and one facility offering
comprehensive care for every 500,000 people.

SERVICE AVAILABILITY

The findings showed that CEmOC services are offered in more than 80 percent of the hospitals assessed (Table 11.5).
One out of five (21 percent) of NGO/not-for-profit hospitals offered CEmOC services. The services are more available
in urban hospitals than rural facilities.
Caesarean section

Blood transfusion

Total number of
CemOC*

facilities

Facility type
Hospital 87% 86% 81% 53
Health center 24% 21% 15% 152
Dispensary N/A N/A N/A 344
Managing authority
Government/public 4% 3% 3% 254
NGO/not-for-profit 21% 25% 21% 17
Private-for-profit 11% 11% 9% 126
Mission/faith based 15% 14% 11% 149
Parastatal N/A N/A N/A 3
Urban/Rural
Rural 5% 5% 4% 328
Urban 8% 7% 7% 221
Total 6% 6% 5% 549

TABLE 11.5
Percentage of facilities offering CemOC services

32
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

In terms of health facilities readiness to provide comprehensive care (Figure 11.6), the mean availability of tracer
items among facilities that provide caesarean section was 68 percent (n=89) while availability of all items in facilities
is very low at 2 percent. Specifically, staff trained on anaesthesia and surgery were very good 92 percent and 95
percent respectively. Blood supply safety was at 72 percent while less than half (46 percent) of the health facilities
had blood supply sufficiency. For equipment, there was 84 percent resuscitation table and 80 percent of spinal
needle available but only 30 percent of anaesthesia equipment.

At least 1 trained staff CEmOC 58%

Staff trained in anaesthesia 92%

Staff trained in surgery 95%

Guidelines available CEmOC 49%

Oxygen 73%

Resuscitation table 84%

Spinal needle 80%

Anaesthesia equipment 30%

Incubator 44%

Blood typing 88%

Cross match testing 48%
Atropine (injectable) 84%
Blood supply safety 72%
Epinephrine (injectable) 97%
Halothane (inhalation) 58%
Ketamine (injectable) 96%
Lidocaine 5% 50%
Suxamethonium bromide (powder) 54%
Thiopental (powder) 55%
Blood supply sufficiency 46%
Mean availability of tracer items 68%
Percent of facilities with all items 2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Equipment Diagnostics Medicines and Commodities Readiness Score

FIGURE 11.6
Facilities with delivery services that have tracer items for comprehensive obstetric care services (n=89)

11.6 CHILD IMMUNIZATION SERVICES

Child immunization is one of the most cost-effective health interventions, providing protection to children against
vaccine-preventable diseases. The Expanded Programme on Immunization (EPI) was established in Tanzania in
1984. Children were considered to be fully vaccinated if they received three doses of a BCG vaccination against
tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertussis, and tetanus; at least three doses of polio
vaccine; and one dose of measles vaccine during infancy.
EPI has been very successful in Tanzania, achieving consistent coverage rates of above 80 percent for more than a
decade. The TDHS-MIS 2015/16 had 97 percent coverage for BCG, first dose of polio and pentavalent vaccines was
97 percent, 95 percent of pneumococcal and 94 percent of rotavirus. Measles vaccine given at around nine months
of age was 87 percent. Overall the percent of children receiving all the basic vaccination.

33
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
SERVICE AVAILABILITY

Health facilities reporting to offer child immunization services on the day of the assessment were 84 percent (Figure
11.7). Less than five percent of the health facilities reported to offer daily, monthly or quarterly child immunization
outreach services. Fifty-eight percent of the health facilities reported to offer daily child immunization services where
54 percent reported to offer infant vaccines. Half of the health facilities reported to offer HPV vaccine.
The assessment showed that more health facilities in rural areas were better off in the availability of immunization
services compared to urban health facilities. For example, rural health facilities offered more birth doses compared to
urban facilities (57 percent vs 40 percent), more infant vaccines (58 percent vs 42 percent), adolescent vaccines (56
percent vs 35 percent), and daily child immunizations (59 percent vs 55 percent). Government and NGO/not-for-profit
facilities were generally better in terms of immunization services compared to other managing authorities.

Offers child immunization services 84%

Adolescent/adult vaccines 50%

Birth doses 53%

Child immunizations offered daily as outreach 4%

Child immunizations offered daily in facility 58%

Child immunizations offered monthly as outreach 34%

Child immunizations offered monthly in facility 3%

Child immunizations offered other basis as outreach 12%

Child immunizations offered other basis in facility 2%

Child immunizations offered quarterly as outreach 1%

Child immunizations offered quarterly in facility 0%

Child immunizations offered weekly as outreach 7%

Child immunizations offered weekly in facility 21%

Infant vaccines 54%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 11.7
Percentage of facilities with immunization services available (N=549)

SERVICE READINESS

Health facilities offering child immunization services (452 facilities) were assessed on their readiness to provide the
service based on the availability of the eight tracer items i.e. refrigerator, sharps box, syringes, and measles,
DTP-Hib-HepB, polio, and BCG vaccines. Mean availability of tracer items was 76 out of 100 (Figure 11.8). Overall,
readiness of health facilities to deliver tracer items was quite high: each individual item was available in over 80% of
facilities that offer child immunization services. Almost all facilities had disposable or auto-disable syringes (96
percent) and sharps boxes (99 percent). Availability of refrigerators and cold boxes with ice packs was also very high
(92 percent and 96 percent respectively). Availability of the four antigens ranged was also high with 85 percent for
pneumococcal vaccine to 89 percent for both measles and rotavirus and 90 percent for DPT-HB+HepB vaccine.
Facilities in rural was more likely to have more of the guidelines, equipment, medicines and commodities and
diagnostic services compare to urban facilities. The mean availability of tracer items was 77 percent in rural compared
to 73 percent in urban facilities. There was not big variation in the mean availability across managing authorities. This
ranged between 74 percent for private for profit facilities to 79 percent for NGO/Not-for-profit. Government facilities
had more staff (75 percent) whereas parastatal facilities had the least percent of staff trained in immunization (38
percent).

34
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Guidelines available child immunization 80%
At least one staff trained child immunization 74%
Auto-disable syringes 96%
Cold box with ice packs 96%
Refrigerator 92%
Sharps container 99%
Adequate refrigerator temperature 54%
Immunization cards 98%
Immunization tally sheets 94%
Temperature monitoring device in refrigerator 62%
DPT-HiB+HepB vaccine 90%
BCG vaccine 86%
HPV (Human Papillomavirus) vaccine* 0%
IPV (Inactivated Poliovirus Vaccine)* 0%
Measles vaccine 89%
Oral polio vaccine 86%
Pneumococcal vaccine* 85%
Rotavirus vaccine* 89%
Mean availability of tracer items 76%
Percent of facilities with all items 0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Equipment Medicines and Commodities Readiness Score

FIGURE 11.8
Percentage of facilities that have tracer items for child immunization services
among facilities that provide immunization services (n=415)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
CHILD AND
ADOLESCENT
HEALTH

12
 12.1 CHILD PREVENTIVE AND CURATIVE SERVICES

Tanzania has made significant progress in the last decade in improving child survival. The TDHS-MIS 2015-16 shows
that under five mortality rates have declined from 81 deaths per 1000 to 67 deaths per 1000 live births. Similar gains
have been observed in infants where mortality also declined from 51 to 43 deaths per 1000 livebirths during the
same period. We however have not seen similar improvements in newborns. Neonatal mortality has remained at
around 25 deaths per 1000 livebirths.
One of the child health services strategy the MOHCDGEC has been implementing is IMCI. Tanzania adopted the
integrated management of childhood illnesses (IMCI) strategy in 1996 and implementation started in 1997. IMCI
strategy has three components i.e. improving performance of health workers (case management skills), improving
health systems (health systems component), and improving family and community practices (community compo-
nent). During the expansion of IMCI, the ministry key focused on the first two components by intensifying efforts in
the delivery of interventions such as promotion and support for nutrition, immunization, and management of
common childhood illnesses at health facility level.

Service availability
Figure 12.1 below shows the percentage of facilities that offer child health preventative and curative care services.
Most of the facilities (93 percent) assessed reported to offer preventive and curative services for children under five
years of age. The percentage of health facilities offering treatment of malaria, child growth monitoring and diagno-
sis of treatment of malnutrition were high at 91, 91 and 89 percent. Two thirds (68 percent) of health facilities
assessed reported offering iron supplementation.

Offers preventive and curative care for U-5s 93%

Diagnosis/treat malnutrition 89%

Vitamin A supplementation 84%

Iron supplementation 68%

Child growth monitoring 91%

ORS and zinc supplementation to children with diarrhea 82%

Administration of amoxicillin for the treatment of pneumonia in 77%

children

Treatment of malaria in children 92%

Treatment of pneumonia 77%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 12.1
Percentage of facilities that offer child health preventative and curative care services (N=549)

37
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
The percent of rural health facilities offering preventive and curative services was higher compared to urban health
facilities in most services with the exception of iron supplementation (67 percent) compared to (77 percent) and
administration of amoxicillin for the treatment of pneumonia in children (77 percent) compared to (78 percent).
There were no major variations in offering of preventive and curative services by facility type with the exception of
iron supplementation. Iron supplementation ranged from 84 percent in hospital to 67 percent in dispensaries. Private
for profit facilities were less likely to offer preventive and curative services compared to other managing authorities
assessed.

pneumonia in children
children with diarrhea
Iron supplementation

Treatment of malaria
supplementation to

amoxicillin for the

Administration of
Offers preventive
and curative care

supplementation

Total number of
Diagnosis/treat

ORS and zinc

Child growth

Treatment of

treatment of
malnutrition

pneumonia
monitoring

in children
Vitamin A

facilities
for U-5s

Facility type
Hospital 97% 85% 97% 84% 89% 96% 84% 90% 96% 53
Health center 95% 93% 92% 71% 87% 94% 80% 80% 95% 152
Dispensary 93% 89% 82% 67% 81% 90% 76% 76% 92% 344
Managing authority
Government/public 98% 95% 90% 73% 86% 98% 86% 79% 96% 254
NGO/not-for-profit 98% 91% 87% 96% 98% 98% 80% 61% 98% 17
Private-for-profit 64% 52% 38% 40% 58% 46% 31% 58% 63% 126
Mission/faith based 90% 81% 80% 59% 80% 83% 58% 80% 88% 149
Parastatal 68% 68% 68% 68% 68% 68% 27% 68% 68% 3
Urban/Rural
Rural 95% 92% 86% 67% 85% 93% 84% 77% 94% 328
Urban 87% 81% 78% 70% 75% 83% 55% 78% 86% 221
Total 93% 89% 84% 68% 82% 91% 77% 77% 92% 549

TABLE 12.1
Percentage of facilities that offer child health preventative and curative care services (N=549)

SERVICE READINESS

Health facilities offering child health services (475 facilities) were also assessed on their readiness to provide curative
care and growth monitoring for children based on the availability of the 15 tracer items. Mean availability index of
tracer items was 70 out of 100 as shown in Figure 12.2.
Overall, availability of equipment was higher compared to other tracer items. Four of the five tracer items in the
equipment category were over 75 percent. Stethoscopes and thermometers were the highest with 94 and 91 percent
respectively. Readiness of health facilities to perform malaria diagnosis was almost universal (99 percent), however,
only one third and one sixth of health assessed reported readiness to conduct hemoglobin tests and testing for
parasites in stool.

38
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Guidelines for growth monitoring 50%

Guidelines for IMCI 76%

Staff trained in IMCI 44%

Staff trained in growth monitoring 45%

Stethoscope 94%

Thermometer 91%

Growth chart 77%

Length/height measuring equipment 81%

Child and infant scale 66%

Malaria diagnostic capacity 99%

Test parasite in stool 16%

Haemoglobin 32%

Me-/albendazole cap/tab 88%

Amoxicillin syrup/suspension 62%

Co-trimoxaxole syrup/suspension 81%

ORS packet 91%

Paracetamol syrup/suspension 81%

Zinc tablets or syrup 68%

Vitamin A capsules 80%

Mean availability of tracer items 70%

Percent of facilities with all items 2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability
Staff and Guidelines Equipment Diagnostics Medicines and Commodities Readiness Score

FIGURE 12.2
Percentage of facilities that have tracer items for child health preventative and curative care
services among facilities that provide this service (n=475)

There were some variations in health facilities readiness in medicines and commodities. Oral rehydration salt (ORS),
Mebendazole capsules or tablets were the most common tracer items at 91 percent and 88 percent respectively. The
least common medicine and commodities were zinc tablets or syrup (68 percent) and Amoxycillin syrup or
suspension (62 percent). Three quarters (76 percent) of health facilities assessed reported readiness in term of
having guidelines for IMCI in place. Either half or less than half of the health facilities assessed had guidelines for
growth monitoring (50 percent), staff trained on growth monitoring (45 percent) or staff trained on IMCI (44
percent). Health centers were more likely (82 percent) to have guidelines for IMCI compared to hospitals (70) and
dispensaries (76). Similarly, the percent of rural facilities with guidelines for IMCI (78 percent) was higher compared
to urban facilities (71 percent). The percent of hospitals (87 percent) and health centers (79 percent) that were
ready to perform hemoglobin test was three times higher compared to that of dispensaries (24 percent). Malaria
diagnostic capacity was almost universal across facility type, managing authority and residence.

Almost nine out of ten health facilities assessed reported availability of ORS. Mission or faith-based and private for
profit facilities reported slightly lower percentages of ORS compared to other managing authorities 80 percent and
81 percent respectively.

39
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
12.2ADOLESCENT REPRODUCTIVE HEALTH SERVICES

Globally, there has been an increasing interest in adolescent health issues (WHO, 2011). Adolescence is a rapid phase
of growth with enormous vulnerability and specific services needs. Nutrition deficiencies including iron deficiency
with the highest prevalence at the age of 12-15 years when requirements are at a peak (WHO, 2011). In Tanzania,
prevalence of anemia is high (45 percent) among women of reproductive age (15-49 years) with limited specific data
on all age range of adolescents (DHS, 2015). Adolescent girls face marriage at an early age and the exposure to a
greater risk of reproductive morbidity and mortality. Modernization coupled with poverty predispose adolescent in
urban settings to poor nutrition, risk behaviors and stress/depression. The adolescent health services are specific
services provided to the group including HIV testing and counselling services, family planning services to adolescents,
provision of combined oral contraceptive pills, provision of male condoms, provision of emergency contraceptive pills,
provision of intrauterine contraceptive device (IUCD) and provision of ART to adolescents.
SERVICE AVAILABILITY

The findings showed that adolescent health service availability in health facilities was 63 percent (Table 12.2). HIV
testing and counselling services to adolescents was 70 percent, of those, only half were provided ART (36 percent).
Family planning services to adolescents was 60 percent.

Provision of intrauterine
Provision of emergency
Provision of combined

(IUCD) to adolescents
contraceptive device
counselling services

pills to adolescents

contraceptive pills
oral contraceptive
Offers adolescent

Provision of male

Provision of ART
Family planning

Total number of
HIV testing and
health services

to adolescents

to adolescents

to adolescents
adolescents

adolescents
condoms to
services to

facilities
Facility type
Hospital 75% 91% 56% 53% 73% 49% 42% 94% 53
Health Centre 67% 81% 71% 66% 76% 57% 43% 79% 152
Dispensary 62% 68% 59% 58% 80% 37% 18% 28% 344
Managing authority
Government/public 72% 78% 71% 68% 95% 46% 22% 40% 254
NGO/not-for-profit 66% 81% 58% 62% 58% 55% 51% 73% 17
Private-for-profit 30% 30% 24% 25% 26% 14% 21% 8% 126
Mission/faith based 34% 53% 25% 22% 32% 19% 12% 31% 149
Parastatal 68% 100% 68% 68% 68% 0% 0% 27% 3
Urban/Rural
Rural 64% 71% 59% 57% 83% 38% 20% 36% 328
Urban 59% 67% 64% 63% 69% 44% 25% 38% 221
Total 63% 70% 60% 58% 79% 40% 21% 36% 549

TABLE 12.2
Adolescent health availability

40
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

In terms of adolescent health service readiness, the mean availability of tracer items was 52% (Figure 12.3). Although
the HIV diagnostic capacity was 97% and medicines and commodities (condom) at 91%, there was low availability
of specific tracer adolescent items – guidelines 31%;staff providing family planning services trained in adolescent
sexual and reproductive health was 39%; staff providing HIV testing and counselling services trained in HIV/AIDS
prevention, care; and management for adolescents 25%, staff trained in provision of adolescent health services 29%
while availability of all tracer items was only 13%.

Guidelines for service provision to adolescents 31%

Staff providing family planning services trained in adolescent sexual 39%

and reproductive health

Staff providing HIV testing and counselling services trained in 25%

HIV/AIDS prevention, care, and management for adolescents

Staff trained in provision of adolescent health services 29%

HIV diagnostic capacity

Condoms 91%

Mean availability of tracer items 52%

Percent of facilities with all items 13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Diagnostics Medicines and Commodities Readiness Score

FIGURE 12.3
Percentage of facilities that have tracer items for adolescent health services among
facilities that provide this service (n=287)
HIV/AIDS prevention,care
in adolescent sexual and
planning services trained
Staff trained in provision
provision to adolescents

Percent of facilities with

HIV diagnostic capacity
testing and counselling
Guidelines for service

Staff providing family

of adolescent health

reproductive health

Mean availability of
Staff providing HIV

services trained in

Total number of
tracer items
Condoms

all items

facilities
services

Facility type
Hospital 50% 60% 45% 51% 100% 97% 20% 67% 37
Health centre 40% 48% 48% 48% 99% 93% 21% 63% 98
Dispensary 28% 24% 38% 20% 96% 91% 11% 50% 152
Managing authority
Government/public 33% 28% 39% 25% 98% 94% 14% 53% 195
NGO/not-for-profit 14% 14% 15% 14% 100% 88% 3% 41% 9
Private-for-profit 14% 37% 60% 26% 88% 76% 5% 50% 33
Mission/faith based 22% 36% 30% 28% 91% 71% 8% 46% 48
Parastatal 60% 0% 40% 40% 100% 100% 0% 57% 2
Urban/Rural
Rural 31% 26% 37% 24% 96% 92% 13% 51% 181
Urban 31% 38% 47% 29% 99% 87% 10% 55% 106
Total 31% 29% 39% 25% 97% 91% 13% 52% 287

TABLE 12.3
Percentage of facilities that have tracer items for adolescent health services among
facilities that provide this service (n=287)

41
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
COMMUNICABLE
DISEASES

13
 13.1 HIV COUNSELLING AND TESTING

The UNAIDS 90-90-90 target calls on countries to reach by 2020, 90 percent of people living with HIV know their
status; 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90
percent of all people receiving ART will have viral suppression. The strength of the health system in terms of care and
services availability and readiness of routine health system has a bearing in attaining the ambitious HIV goal.

SERVICE AVAILABILITY

Of the 549 health facilities that were sampled, 92% reported availability HIV counselling and testing services (Table
13.1). Hospitals had universal availability of HIV counselling and testing services. Other facility types had similarly high
availability at 96 percent for health centers and 91 percent for dispensaries. Rural health facilities reported slightly
higher availability of HIV counselling and testing services compared to urban health facilities 93 percent versus 88
percent respectively

Offers HIV counselling and Total number of facilities

testing services

Facility type
Hospital 100% 53
Health Center 96% 152
Dispensary 91% 344
Managing authority
Government/public 97% 254
NGO/not-for-profit 98% 17
Private-for-profit 57% 126
Mission/faith based 84% 149
Parastatal 100% 3
Urban/Rural
Rural 93% 328
Urban 88% 221
Total 92% 549

TABLE 13.1
Percentage of health facilities offering HIV counselling and testing services (N=549)

SERVICE READINESS

The mean availability of HIV counselling and testing tracer items was 76 percent with only 33 percent of facilities
having all tracer items (Table 13.2). Guidelines for HIV counselling and testing were available in 70 percent of the
health facilities, presence of at least 1 trained staff for HIV counselling and testing was 52 percent and rooms with
privacy was 72 percent. Overall HIV diagnostic capacity was very good at 99 percent. Availability of condoms was
high at 85% with their availability more in rural than in urban health facilities.

43
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 At least 1 trained staff

Room with visual and

HIV counselling and

HIV counselling and

Guidelines available

Mean availability of
Percent of facilities
auditory privacy

Total number of
HIV diagnostic

with all items

tracer items
Condoms
capacity

facilities
testing

testing
Facility type
Hospital 82% 66% 93% 100% 80% 46% 84% 53
Health Center 82% 63% 75% 100% 76% 38% 79% 146
Dispensary 68% 49% 70% 99% 86% 32% 75% 268
Managing authority
Government/public 73% 52% 69% 100% 92% 36% 77% 248
NGO/not-for-profit 92% 69% 100% 100% 59% 48% 84% 16
Private-for-profit 44% 55% 82% 95% 65% 24% 68% 73
Mission/faith based 64% 46% 79% 96% 44% 17% 66% 127
Parastatal 73% 68% 100% 100% 100% 41% 88% 3
Urban/Rural
Rural 70% 49% 71% 99% 87% 34% 75% 283
Urban 73% 60% 73% 100% 79% 29% 77% 184
Total 70% 52% 72% 99% 85% 33% 76% 467

TABLE 13.2
Percentage of facilities that have tracer items for HIV counselling and testing services among
facilities that provide this service (n=467

13.2 HIV CARE AND SUPPORT

The care and support services for HIV/ AIDS include nutritional rehabilitation services, family planning counselling,
preventative and treatment for opportunistic infections, provision of palliative care, prescription of preventative
treatment for TB, care for pediatric HIV/AIDS patients, prescription of fortified protein and micronutrient
supplementation, IV treatment of fungal infections, treatment for Kaposi’s sarcoma and provision of condoms.

SERVICE AVAILABILITY

Of the surveyed facilities, 51 percent were offering HIV/AIDS care and support services (Figure 13.1). The provision of
specific services in facilities were mostly below 50 percent. Preventative treatment for opportunistic infections was
47 percent, care for pediatric HIV/AIDS patients was 39 percent, prescription of micronutrient supplementation was
in 39 percent of the facilities, treatment of opportunistic infections 50 percent, IV treatment of fungal infections was
18 percent, treatment for Kaposi’s sarcoma 9 percent and provision of condoms was 47 percent.

44
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Offers HIV care and support services 51%

Nutritional rehabilitation services 37%

Family planning counselling 49%

Preventative treatment for opportunistic infections 47%

Provision of palliative care 42%

Provide/prescribe preventative treatment for TB 24%

Care for paediatric HIV/AIDS patients 39%

Provide/prescribe fortified protein supplementation 13%

Provide/prescribe micronutrient supplementation 39%

Treatment of opportunistic infections 50%

IV treatment of fungal infections 18%

Treatment for Kaposi's sarcoma 9%

Provide condoms 47%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 13.1
Percentage of facilities that offer HIV/AIDS care and support services (N=549)

SERVICE READINESS

Figure 13.2 shows health facilities that have tracer items for HIV care and support services among facilities that
provide HIV/ADS services. The mean availability of tracer items was 65% with only 3% of facilities having all items 3%
(n=314).
Availability of medicines and commodities was high except for IV treatment for fungal infections (13 percent) and all
first line TB medication (46 percent). Condoms were available in 83 percent of health facilities, co-trimoxazole
capsules or tablet (91 percent), palliative care pain management, intravenous solution with infusion set in 88 percent
of health facilities.

Guidelines available clinical management HIV/AIDS 78%

Guidelines available palliative care 42%

At least 1 trained staff clinic management HIV/AIDS 58%

System for diagnosis of TB among HIV+ clients 54%

Condoms 83%

Co-trimoxazole cap/tab 91%

Palliative care pain management 96%

Intravenous solution with infusion set 88%

All first line TB medications 46%

IV treatment fungal infection 13%

Mean availability of tracer items 65%

Percent of facilities with all items 3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Perentage availability

Staff and Guidelines Diagnostics Medicines and Commodities Readiness Score

FIGURE 13.2
Percentage of facilities that have tracer items for HIV care and support services among facilities
that provide this service (n=314)

45
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 13.3 SEXUALLY TRANSMITTED INFECTIONS

There is strong evidence of an association between sexually transmitted infections and sexually transmitted HIV. If not
properly treated STIs can cause severe illness, infertility and long-term disability. Sexually transmitted infections in
pregnant women can lead to adverse pregnancy outcomes such as stillbirths, miscarriage, preterm birth and
infections in the newborn. The Tanzania HIV-AIDS and Malaria indicator survey 2012 indicates that 7 percent of men
and 8 percent of women reported to have had a sexually transmitted infection (STI), an abnormal discharge, or a
genital sore in the 12 months before the survey. Results from the Tanzania Service Provision Availability (TSPA) 2006
reported that 96 percent of the facilities offered STI services as a primary service while 97 percent of all health
facilities reported to offer STI services as part of general outpatient curative services

SERVICE AVAILABILITY

Table 13.3 shows nine out of ten health facilities assessed during the SARA 2017 reported to offer STIs services. The
percent of health facilities diagnosing and prescribing treatment for STIs was 86 percent and 89 percent respectively.
There was almost universal availability of STIs services in health center (99 percent). The percent of hospitals and
dispensaries offering STI services as similar (88 percent). Urban health facilities were more likely have STIs services
compared to rural health facilities. The percent of urban health facilities offering STI services was 95 percent while
that of rural facilities was 87 percent. NGO/not-for profit and parastatal facilities assessed had universal availability in
terms of offering services, diagnosis and prescribing treatment of STI.
Prescribe treatment for
Offers services for STIs

Total number of f
Diagnosis of STIs

acilities
STIs

Facility type
Hospital 88% 88% 88% 53
Health center 99% 98% 99% 152
Dispensary 88% 84% 88% 344
Managing authority
Government/public 89% 85% 89% 254
NGO/not-for-profit 100% 100% 100% 17
Private-for-profit 86% 85% 86% 126
Mission/faith based 89% 86% 88% 149
Parastatal 100% 100% 100% 3
Urban/Rural
Rural 87% 83% 87% 328
Urban 95% 92% 95% 221
Total 89% 86% 89% 549

TABLE 13.3
Percentage of facilities offering STI services (N=549)

46
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

Facilities (n=503) reporting to offer STI treatment were also assessed on their readiness to provide the service based
on the availability of the seven tracer items. Tracer items assessed included availability of diagnosis and treatment
guidelines for STIs, at least one staff trained on the diagnosis and treatment of STIs, availability of syphilis rapid test,
Ceftriaxone injectable, Metronidazole, condoms and Ciprofloxacin.
Overall, the mean availability of tracer was 70 percent (Figure 13.3). Medicine and commodities such as Metronidazole
(93 percent), Ciprofloxacin (87 percent), condoms (83 percent) were available in most facilities providing STIs
services. Close to two thirds (64 percent) of facilities assessed had guidelines for diagnosis and treatment of STIs.
Only one in five (19 percent) of facilities had at least one staff trained on STIs.

Guidelines available diagnosis and treatment of STIs 64%

At least 1 trained staff diagnosis and treatment of STIs 19%

Syphillis rapid test 62%

Ceftriaxone injectable 79%

Metronidazole 93%

Condoms 83%

Ciprofloxacin 87%

Mean availability of tracer items 70%

Percent of facilities with all items 7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Diagnostics Medicines and Commodities Readiness Score

FIGURE 13.3
Percentage of facilities that have tracer items for STI services among facilities that provide
this service (n=503)

Half (52 percent) of the hospitals had at least one staff trained on diagnosis and treatment of STIs compared to
health centers (37 percent) and dispensaries (15 percent). Approximately one third (30 percent) of urban health
facilities had at least one staff trained on diagnosis and treatment of STIs compared to only 15 percent of rural health
facilities. Metronidazole was the most common medicine with over 90 percent availability in most health facility
levels, more than 80 percent in all managing authority and over 90 percent in both urban and rural facilities.
Availability of Ciprofloxacin and Ceftriaxone injectable was also high at 87 percent and 79 percent respectively, and
did not vary across facility type, managing authority or by residence. Condoms were less likely to be found in mission
and or faith based hospital. Less than half (41 percent) of the facilities assessed reported to have condoms. More rural
health facilities (85 percent) had condoms available compared to urban health facilities (76 percent). Urban health
facilities were better off in terms of availability of diagnostic capacity for syphilis. Three quarters (75 percent) of
urban health facilities had the readiness to test for syphilis using a rapid test as compared to 57 percent of rural health
facilities.

47
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 48
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 AND TREATMENT OF

AND TREATMENT OF
AT LEAST 1 TRAINED

AT LEAST 1 TRAINED
STAFF DIAGNOSIS

STAFF DIAGNOSIS

METRONIDAZOLE
RAPID

SYPHILLIS RAPID

CIPROFLOXACIN
DIAGNOSIS AND

DIAGNOSIS AND
TREATMENT OF

TREATMENT OF
GUIDELINES

GUIDELINES
AVAILABLE

AVAILABLE

CONDOMS

CONDOMS
SYPHILLIS
TEST

TEST
STIS

STIS
STIS

STIS
Facility type Facility type
Hospital Hospital
81% 52% 81%
88% 52%
79% 88%
98% 79%
91%
Health center Health
78% center 37% 78%
75% 37%
77% 75%
95% 77%
88%
Dispensary Dispensary
61% 15% 61%
59% 15%
84% 59%
92% 84%
87%
Managing authority Managing authority
Government/public Government/public
69% 15% 69%
59% 15%
94% 59%
94% 94%
89%
NGO/not-for-profit NGO/not-for-profit
33% 20% 33%
55% 20%
58% 55%
100% 58%
63%
Private-for-profit Private-for-profit
46% 35% 46%
71% 35%
50% 71%
83% 50%
81%
Mission/faith based Mission/faith
52% based32% 52%
74% 32%
41% 74%
87% 41%
84%
Parastatal Parastatal
27% 27% 27%
27% 27%
100% 27%
100% 100%
100%
Urban/Rural Urban/Rural
Rural Rural
65% 16% 65%
57% 16%
85% 57%
94% 85%
86%
Urban Urban
62% 30% 62%
75% 30%
76% 75%
90% 76%
90%
Total Total
64% 19% 64%
62% 19%
83% 62%
93% 83%
87%

TABLE 13.4
Sexually transmitted infections readiness

13.4 TUBERCULOSIS

TB services are provided in Tanzania using the direct observed therapy strategy (DOTS). Owing to scant diagnostic
capability, lower level facilities are expected to refer patients with suspected TB for diagnosis to higher level facilities.
Once diagnosis is confirmed, patients are supposed to receive their treatment from the nearest health facility.

SERVICE AVAILABILITY

Table 13.5 shows the percentage of health facilities offering TB diagnosis, diagnosis methods used and treatment.
Overall, 43% of health facilities offered TB services. The proportion was higher among NGO health facilities that are
not for profit than government health facilities. There was a clear difference in TB services offered between hospitals
(82 percent), health centers (87 percent), and dispensaries (36). Private for profit facilities were also less likely to
offer TB services – no doubt because these services are provided for free in government and NGO health facilities.
No difference was observed in the proportion of facilities offering TB services between rural and urban areas.

49
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 AVAILABILITY

MEAN AVAILABILITY
WITHOF

TOTAL NUMBER OF
TRACER ITEMS

OF TRACER ITEMS
NUMBER
CEFTRIAXONE

PERCENT OF
INJECTABLE

FACILITIES
FACILITIES

FACILITIES
ALL ITEMS
TOTAL
MEAN
OF

95%
83% 28%
52 83% 52
92%
77% 16%
150 77% 150
76%
68% 5%
301 68% 301

79%
71% 7%
239 71% 239
96%
61% 5%
17 61% 17
77%
63% 10%
109 63% 109
76%
64% 8%
135 64% 135
100%
69% 27%
3 69% 3

78%
69% 5%
297 69% 297
81%
72% 14%
206 72% 206
79%
70% 7%
503 70% 503

50 50
ADINESS ASSESSMENT
SERVICE AVAILABILITY
( SARA ) DECEMBER
AND READINESS
| 2017 ASSESSMENT ( SARA ) DECEMBER | 2017
 OFFERS TB SERVICES

TB SERVICES

CLINICAL SYMPTOMS

SYMPTOMS
DIAGNOSIS BY

DIAGNOSTICBY

TB DIAGNOSIS BY
BY
TESTING SMEAR
DIAGNOSTIC
TB DIAGNOSIS

TB DIAGNOSIS

TB DIAGNOSIS

DIAGNOSIS
EXAMINATION
MICROSCOPY

CLINICAL
CULTURE
TESTING

SPUTUM
OFFERS
TB

TB

TB
Facility type Facility type
Hospital Hospital
82% 82% 82%
81% 82%
78% 81%
80% 78%
20%
Health centers Health
87% centers 81% 87%
69% 81%
81% 69%
69% 81%
4%
Dispensary Dispensary
36% 25% 36%
6% 25%
24% 6%
6% 24%
0%
Managing authority Managing authority
Government/public Government/public
46% 33% 46%
13% 33%
32% 13%
13% 32%
1%
NGO/not-for-profit NGO/not-for-profit
81% 77% 81%
33% 77%
73% 33%
33% 73%
2%
Private-for-profit Private-for-profit
19% 19% 19%
8% 19%
19% 8%
8% 19%
3%
Mission/faith based Mission/faith
43% based
39% 43%
32% 39%
39% 32%
32% 39%
2%
Parastatal Parastatal
27% 27% 27%
0% 27%
27% 0%
0% 27%
0%
Urban/Rural Urban/Rural
Rural Rural
42% 33% 42%
15% 33%
32% 15%
15% 32%
1%
Urban Urban
47% 33% 47%
16% 33%
33% 16%
16% 33%
3%
Total Total
43% 33% 43%
16% 33%
32% 16%
15% 32%
1%

TABLE 13.5
Percentage of facilities that offer tuberculosis services (N=549)

TABLE 13.5
Percentage of facilities that offer tuberculosis services (N=549)

SERVICE READINESS
SERVICE READINESS
Health facilities offering TB services (n=279) were also assessed on their readiness to provide the service based on
the availability of the 12 tracer items.
HealthTable 13.6 offering
facilities shows the TBavailability of thesewere
services (n=279) tracer items
also by facility
assessed type,readiness
on their managingto provide
authority, and urban/rural. Availability of different guidelines for diagnostic and treatment of TB, for management of
the availability of the 12 tracer items. Table 13.6 shows the availability of these tracer items by fa
HIV and TB co-infection and for MDR-TB
authority, was
and 73 percent,
urban/rural. 62 percent
Availability and 40 percent
of different respectively.
guidelines Availability
for diagnostic of
and treatment of TB
guidelines was low in both health centers
HIV and and dispensaries
TB co-infection and for for
MDR-TBMDR-TB
was and low for 62
73 percent, TBpercent
infection
andcontrol in
40 percent respe
dispensaries. Overall readiness scores for
guidelines wasprovision
low in of TB health
both servicescenters
amongandfacilities that reported
dispensaries to provide
for MDR-TB and TB low for TB
services was 56 percent. HIV diagnostic capacity within TB services was universal in all levels of facility type, manag-
dispensaries. Overall readiness scores for provision of TB services among facilities that rep
ing authority and by residence. Almostwas
services half56ofpercent.
the dispensaries (49 percent)
HIV diagnostic capacity assessed
within TB were ready
services wastouniversal
provide inTBall levels o
services. TB microscopy is oneing
of the key diagnostic
authority service forAlmost
and by residence. TB clinics.
halfApproximately one in (49
of the dispensaries five percent)
health facilities
assessed were
had TB microscopy capacity. This was mostly found in hospitals (68 percent) and in health centers (55 percent)
services. TB microscopy is one of the key diagnostic service for TB clinics. Approximately one
Availability of trained staff washad
higher in hospitals capacity.
TB microscopy (91 percent)
Thisthan
was in healthfound
mostly centers (81 percent).
in hospitals The pattern
(68 percent) and was
in health cen
very similar for the availabilityAvailability
of staff trained on HIV/TB
of trained co-infection,
staff was while the
higher in hospitals (91proportion withinstaff
percent) than trained
health in (81 perc
centers
management of multi-drug resistant TB wasfor
very similar lower
the particularly
availability at
of health centerson
staff trained and dispensaries.
HIV/TB co-infection, while the proportion
management of multi-drug resistant TB was lower particularly at health centers and dispensari

51 51
SERVICE AVAILABILITY AND READINESS ASSESSMENT
SERVICE AVAILABILITY
( SARA ) DECEMBER
AND READINESS
| 2017 ASSESSM
 MTB/RIF)

FOLLOW-UP FOR TB

FOLLOW-UP FOR TB
MANAGEMENT AND

MANAGEMENT AND
OF OF

TOTAL NUMBER OF
OF

PRESCRIPTION OF
TB DIAGNOSIS BY
DIAGNOSIS BY

NUMBER
PRESCRIPTION

OF
OF TB

DRUGS OF TB
DRUGS TO TB

TO TB
CHEST X-RAY
(GENEXPERT

TREATMENT

TREATMENT
DRUGSTEST

PROVISION

PROVISION
FACILITIES

FACILITIES
PATIENTS

PATIENTS

PATIENTS
PATIENTS

PATIENTS

PATIENTS
DRUGS
TOTAL
RAPID
TB

28%
79% 70%
80% 79%
81% 80%
53 81% 53
10%
78% 5%
79% 78%
81% 79%
152 81% 152
0%
13% 0%
23% 13%
27% 23%
344 27% 344

2%
22% 2%
33% 22%
38% 33%
254 38% 254
8%
77% 14%
73% 77%
73% 73%
17 73% 17
2%
7% 5%
7% 7%
7% 7%
126 7% 126
4%
32% 12%
35% 32%
36% 35%
149 36% 149
0%
27% 0%
27% 27%
27% 27%
3 27% 3

2%
21% 3%
28% 21%
32% 28%
328 32% 328
3%
29% 4%
41% 29%
45% 41%
221 45% 221
2%
23% 3%
31% 23%
35% 31%
549 35% 549

52 52
ADINESS ASSESSMENT
SERVICE AVAILABILITY
( SARA ) DECEMBER
AND READINESS
| 2017 ASSESSMENT ( SARA ) DECEMBER | 2017
 INFECTION CONTROL

INFECTION CONTROL
STAFF MANAGEMENT
AT LEAST 1 TRAINED

AT LEAST 1 TRAINED

AT LEAST 1 TRAINED
AT LEAST 1 TRAINED
STAFF DIAGNOSIS &
GUIDELINESMDR-TB

AVAILABLE MDR-TB
TREATMENT OF TB

TREATMENT OF TB

TREATMENT OF TB
MANAGEMENT OF

MANAGEMENT OF
CO-INFECTION

CO-INFECTION

CO-INFECTION
AVAILABLE TB

AVAILABLE TB

STAFF MDR-TB
DIAGNOSIS &

DIAGNOSIS &
GUIDELINES

GUIDELINES

GUIDELINES

GUIDELINES
GUIDELINES

GUIDELINES

GUIDELINES
OF HIV & TB
AVAILABLE

AVAILABLE

AVAILABLE
AVAILABLE

AVAILABLE
HIV & TB

HIV & TB
Facility type Facility type
Hospital 89%
Hospital 78% 69%
89% 76%
78% 91%
69% 86%
76% 72%
91%
Health Centers 79%
Health Centers 60% 43%
79% 61%
60% 81%
43% 70%
61% 41%
81%
Dispensary 69%
Dispensary 61% 36%
69% 46%
61% 41%
36% 49%
46% 26%
41%
Managing authority Managing authority
Government/public 73%
Government/public
66% 41%
73% 53%
66% 52%
41% 57%
53% 32%
52%
NGO/not-for-profit 49%
NGO/not-for-profit
35% 29%
49% 25%
35% 30%
29% 30%
25% 28%
30%
Private-for-profit 74%
Private-for-profit 32% 21%
74% 30%
32% 35%
21% 33%
30% 25%
35%
Mission/faith based 78%
Mission/faith based
59% 45%
78% 60%
59% 78%
45% 67%
60% 43%
78%
Parastatal 0%
Parastatal 0% 0% 0% 0% 0% 0%
Urban/Rural Urban/Rural
Rural 70%
Rural 63% 38%
70% 46%
63% 50%
38% 53%
46% 32%
50%
Urban 81%
Urban 59% 45%
81% 66%
59% 61%
45% 66% 34%
61%
Total 73%
Total 62% 40%
73% 52%
62% 53%
40% 56%
52% 33%
53%

TABLE 13.6
Percentage of facilities that have tracer items for tuberculosis services among facilities that provide this service (n=279)

TABLE 13.6
Percentage of facilities that have tracer items for tuberculosis services among facilities that provide this

53 53
SERVICE AVAILABILITY
SERVICE AVAILABILITY AND READINESS ASSESSMENT AND READINESS
( SARA ) DECEMBER | 2017 ASSESSM
 FACILITIES WITH ALL

ALL
STAFF TB INFECTION
AT LEAST 1 TRAINED

MEAN AVAILABILITY

MEAN AVAILABILITY
AMONG TB CLIENTS

AMONG TB CLIENTS

WITHOF

TOTAL NUMBER OF
OF HIV

DIAGNOSIS OF HIV
FIRST-LINE TB

ALL FIRST-LINE TB

OF TRACER ITEMS

OF TRACER ITEMS
MICROSCOPY
HIV DIAGNOSTIC

ALL DIAGNOSTIC

NUMBER
MEDICATIONS

MEDICATIONS
PERCENT OF

PERCENT OF
SYSTEM FOR

SYSTEM FOR
DIAGNOSIS

FACILITIES
FACILITIES

FACILITIES
CAPACITY

CAPACITY
CONTROL

TOTAL
ITEMS

ITEMS
HIV
TB

100%
81% 89%
68% 97%
100% 31%
89% 83%
97% 46
31% 83% 46
100%
69% 92%
55% 82%
100% 10%
92% 69%
82% 129
10% 69% 129
99%
42% 61%
7% 50%
99% 1%
61% 49%
50% 104
1% 49% 104

100%
51% 69%
17% 62%
100% 4%
69% 56%
62% 176
4% 56% 176
100%
25% 84%
20% 43%
100% 7%
84% 42%
43% 13
7% 42% 13
94%
39% 40%
41% 32%
94% 15%
40% 41%
32% 19
15% 41% 19
98%
66% 88%
51% 71%
98% 9%
88% 67%
71% 70
9% 67% 70
100%
0% 0% 0%
100% 0% 8%
0% 10% 8% 1

100%
48% 71%
23% 55%
100% 5%
71% 54%
55% 187
5% 54% 187
99%
58% 69%
18% 76%
99% 6%
69% 61%
76% 92
6% 61% 92
100%
51% 70%
22% 61%
100% 6%
70% 56%
61% 279
6% 56% 279

54 54
SERVICE AVAILABILITY
ADINESS ASSESSMENT AND READINESS
( SARA ) DECEMBER | 2017 ASSESSMENT ( SARA ) DECEMBER | 2017
 13.5 MALARIA

Malaria has been and continues to be the major cause of outpatient attendance, inpatient admission and the leading
cause of deaths among children under-fives in sub- Saharan Africa, accounting for about 20 percent of childhood
death. In recent years, the National Malaria Control Program in collaboration with other stakeholders such as Global
Fund, US President’s Malaria Initiative (PMI), UNICEF and others have made major progress in reducing the burden in
vulnerable groups i.e. children and pregnant women. Strategies employed have included prompt diagnosis and
treatment of malaria with effective drugs, free distribution of insecticide treated nets, intermittent preventive
treatment during pregnancy, indoor residual spraying and strengthening the monitoring and evaluation surveillance
systems to support localized control.

SERVICE AVAILABILITY

Malaria diagnosis and/or treatment services were nearly universal in all health facilities with some variation in the
diagnostic methods used. Malaria diagnosis by rapid diagnostic test (RDTs) was the most commonly used method
(98 percent), while microscopy was used in over a quarter (28 percent) of all health facilities, mostly hospitals (87
percent) and health centers (81 percent). Approximately half (51 percent) of malaria diagnosis was by clinical
symptoms. Intermittent preventive treatment (IPT) was high (91 percent) and mostly available in public facilities
compared to private-for-profit. The availability of malaria treatment was universal across facility type, managing
authority and by residence.
treatment of malaria

Malaria diagnosis by

Malaria diagnosis by

Malaria diagnosis by
Offer diagnosis or

clinical symptoms

Malaria treatment
Malaria diagnosis

Malaria diagnosis

Total number of
microscopy

facilities
testing

RDT

IPT

Facility type
Hospital 100% 100% 100% 63% 100% 87% 99% 93% 53
Health Center 100% 100% 100% 56% 99% 81% 100% 92% 152
Dispensary 100% 100% 99% 50% 98% 19% 99% 90% 344
Managing authority
Government/public 100% 100% 99% 51% 99% 14% 100% 98% 254
NGO/not-for-profit 100% 100% 100% 41% 100% 55% 100% 81% 17
Private-for-profit 98% 97% 98% 51% 92% 75% 97% 52% 126
Mission/faith based 99% 99% 98% 53% 96% 76% 99% 77% 149
Parastatal 100% 100% 100% 73% 100% 100% 100% 68% 3
Urban/Rural
Rural 100% 100% 100% 49% 99% 21% 100% 94% 328
Urban 99% 99% 98% 60% 96% 49% 98% 82% 221
Total 100% 100% 99% 51% 98% 28% 99% 91% 549

TABLE 13.7
Percentage of facilities that offer malaria services (N=549)

55
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

Figure 13.3 shows availability of specific inputs (personnel, guidelines, diagnostics, and medicines) for malaria
services among health facilities that offered malaria diagnosis and treatment services. Availability of the first line
antimalarial drug at the time of survey ranged between 47 percent in dispensaries to 72 percent in hospitals. Nearly
all facilities had the capacity to diagnose malaria using either RDT or microscopy. SP for IPTp was in stock in 82
percent of health facilities. Paracetamol was available in 92 percent of facilities. The “availability of ITN” described
here may be misleading and it is certainly lower (21 percent of all facilities) than would be expected. The
questionnaire was modified to include either ITNs or vouchers, but it may not have been understood fully by
enumerators or respondents. 66 percent of all facilities had at least one staff member trained in diagnosis and
treatment of malaria. Proportion of facilities with staff trained in IPTp was marginally lower particularly at the private
facilities. 76 percent of health facilities had guidelines for diagnosis and treatment of malaria, while 67 percent had
guidelines for IPTp. Overall, there was no variation in the rural and urban facilities on how they were capable of
offering malaria services.

Guidelines available diagnosis and treatment of malaria 76%

At least 1 trained staff diagnosis and treatment of malaria 66%

Guidelines available IPT 67%

At least 1 trained staff IPT 46%

Malaria diagnostic capacity 99%

First-line antimalarial in-stock 49%

Paracetamol cap/tab 92%

IPT drug 82%

ITN 26%

Mean availability of tracer items 72%

Percent of facilities with all items 13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Diagnostics Medicines and Commodities Readiness Score

FIGURE 13.4
Percentage of facilities that have tracer items for malaria services among facilities
that provide this service (n=545)

56
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
NON-COMMUNICABLE
DISEASES

14
 There is increasing evidence of the growing burden of disease due to non-communicable diseases (NCDs) such as
diabetes, hypertension and cancers in developing countries including Tanzania. The burden is exacerbated by the
change in lifestyle of population in urban areas and to some extent in the rural areas. Unhealthy diet, lack of exercises,
alcohol and tobacco use and excess use of salt are preventable major risks factors for chronic disease responsible for
this increase. The World Health Organization STEPS survey conducted in 2012 collected local up-to-date evidence on
the prevalence of selected NCDs. Key findings suggests that there is relatively high prevalence of NCD risk factors.
Approximately 16% of the 25-64 years old surveyed were current tobacco users, almost 30% were current alcohol
drinkers, and 93 percent of the population surveyed ate less than 5 servings of fruit and/or vegetables on average per
day. One out of four (26 percent) were overweight and obese and had raised cholesterol. The prevalence of diabetes
was found to be 9 percent and 26 percent for hypertension.

SERVICE AVAILABILITY

Diabetes
Approximately one third (31 percent) of the health facilities assessed during the SARA 2017 reported to offer
diagnosis and or management of diabetes. Hospitals (86 percent) and health centers (71%) were more likely to offer
this service. Health facilities from other managing authorities other than the government or public health facilities
were more likely to offer diabetes diagnosis and management services. The percent of government or public health
facilities offering diagnosis and or management of diabetes was 20 percent, whereas the percent of private for profit
health facilities was 76 percent. Availability of diabetes services in rural was 26 percent compared to 48 percent in
urban areas.

Diabetes diagnosis and/or Total number of facilities

management

Facility type
Hospital 86% 53
Health Center 71% 152
Dispensary 24% 344
Managing authority
Government/public 20% 254
NGO/not-for-profit 58% 17
Private-for-profit 76% 126
Mission/faith based 62% 149
Parastatal 68% 3
Urban/Rural
Rural 26% 328
Urban 48% 221
Total 31% 549

TABLE 14.1
Percentage of facilities that offer diabetes services (N=549)

58
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

Health facilities (n=308) assessed for availability of diabetes diagnosis and management were also assessed for
readiness to provide the service. The mean availability of tracer items for diabetes services was 49 percent.
Availability of equipment for diabetes services was high. Adult scale and blood pressure apparatus was almost
universal (99 percent), measuring tape was 80 percent. Staff and guidelines for diabetes services was low. Only 20
percent of facilities had at least one staff trained on diagnosis and management of diabetes and 22 percent had
guidelines on the day of assessment. Less than half (47 percent) of the hospitals and approximately one out of three
(29 percent) of health centers had staff trained on diabetes diagnosis and management.
Diagnostic capacity was available in more than half of the health facilities. Availability of urine dipstick for protein and
for ketones was 64 percent and 60 percent respectively. Two thirds (66 percent) of the facilities were ready to
provide diagnostic tests for blood glucose. Health facilities in urban settings were more prepared to perform
diagnostic tests for diabetes than health facilities in rural areas. For example, testing for blood glucose was 78
percent compared to 59 percent, urine dipstick for protein 81 percent compared to 53 percent and urine dipstick for
kerotine 79 percent compared to 49 percent in urban compared to rural areas respectively.
Availability of medicines and commodities for diabetes was generally low. The percent of health facilities reporting to
have Metformin and Glibenclamide was 45 percent and 40 percent respectively. Insulin regular injectable was
available in only 19 percent of the facilities assessed.

At least 1 trained staff diabetes diagnosis and treatment 20%

Guidelines available diabetes diagnosis and treatment 22%
Adult scale 99%
Blood pressure apparatus 99%
Measuring tape 80%
Urine dipstick- protein 64%
Urine dipstick- ketones 60%
Blood glucose 66%
Glucose 50% injectable 19%
Gliclazide tablet or glipizide tablet 7%
Insulin regular injectable 19%
Metformin 45%
Glibenclamide 40%
Mean availability of tracer items 49%
Percent of facilities with all items 1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Equipment Diagnostics Medicines and Commodities Readiness Score

FIGURE 14.1
Percentage of facilities that have tracer items for diabetes services among
facilities that provide this service (n=308)

59
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Cardio-vascular disease (CVD)

SERVICE AVAILABILITY

Cardio-vascular disease (CVD) diagnosis and management were more likely to be offered at hospitals (86 percent)
and health centers (81 percent). The same was true at private for profit (74 percent) and at mission or faith-based
facilities (66 percent) than at government facilities (41 percent). The services were also more available in urban than
in rural health facilities. Overall, CVD services were offered in approximately half (48 percent) of the health facilities
assessed in the SARA 2017.

Offers cardiovascular disease Total number of facilities

diagnosis and/or management

Facility type
Hospital 86% 53
Health Center 81% 152
Dispensary 42% 344
Managing authority
Government/public 41% 254
NGO/not-for-profit 52% 17
Private-for-profit 74% 126
Mission/faith based 66% 149
Parastatal 41% 3
Urban/Rural
Rural 42% 328
Urban 63% 221
Total 48% 549

TABLE 14.2
Percentage of facilities offering CVD diagnosis and management services (N=549)

SERVICE READINESS

Out of 549 facilities, three quarters (n=355) offered disease diagnosis and/or management for cardio-vascular
disease (CVD). The overall mean availability index for tracer items for CVD diagnosis and management was 43
percent. Availability of equipment for diagnosis and or management of CVD was similar to that for diabetes with
the exception of oxygen which was only available in 14 percent of the health facilities. The percent of staff and
guidelines was 12 percent and 24 percent respectively which is still quite low with respect to the increasing burden.
Aspirin was the most commonly available drug (64 percent) in health facilities among tracer items in the medicine
and commodities category. ACE inhibitors (12 percent) and Hydrochlorothiazide tablets (12 percent) used for the
management of high blood pressure were the least available medicines. One in five (20 percent) of the health
facilities reported having beta blockers.
Hospitals were more likely to have the equipment e.g. stethoscope, blood pressure apparatus and adult scales;
medicine and commodities such as ACE inhibitors compared to other levels such as health centers and dispensaries.
This is low due the manning levels at these type of facilities. Medicines for management of CVD were less likely to be
found in government or public health facilities as compared to other managing authorities with the exception of
parastatal facilities which had none. It should be noted though that the majority of government and public health
facilities were dispensaries where these services are probably not being offered because they are only available at
higher level facilities according to the MOHCDGEC categorization of specific service provision.

60
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Guidelines available CVD diagnosis and management 24%
At least 1 trained staff CVD diagnosis and management 12%
Blood pressure apparatus 93%
Stethoscope 98%
Adult scale 99%
Oxygen 14%
ACE inhibitors 12%
Aspirin 64%
Beta blockers 20%
Calcium channel blockers 33%
Hydrochlorothiazide tablet 12%
Metformin 31%
Mean availability of tracer items 43%
Percent of facilities with all items 1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

Staff and Guidelines Equipment Medicines and Commodities Readiness Score

FIGURE 14.2
Percentage of facilities that have tracer items for cardiovascular disease services among
facilities that provide this service (n=355)

Chronic Respiratory Disease

SERVICE AVAILABILITY

Availability of chronic respiratory disease (CRD) services was reported in one third (34 percent) of the facilities
assessed in SARA 2017. While comparing the percent of facilities offering chronic respiratory disease diagnosis
and/or management, hospitals were more likely (86 percent) to offers this service compare to health centers (71
percent) and dispensaries (27 percent). Other managing authorities were twice more likely to offer CRD services
compared to government of public facilities (28 percent).

61
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Offers chronic respiratory disease Total number of facilities
diagnosis and/or management

Facility type
Hospital 86% 53
Health Center 71% 152
Dispensary 27% 344
Managing authority
Government/public 28% 254
NGO/not-for-profit 56% 17
Private-for-profit 54% 126
Mission/faith based 54% 149
Parastatal 68% 3
Urban/Rural
Rural 28% 328
Urban 52% 221
Total 34% 549

TABLE 14.3
Percentage of facilities that offer chronic respiratory disease services (N=549)

SERVICE READINESS

Out of 549 facilities, 60 percent (n=295) offered disease diagnosis and/or management for chronic respiratory
disease (CRD). The overall mean availability index for tracer items for CRD diagnosis and management was 42
percent. Availability of guidelines was 44 percent, better than for CVD and diabetes. Availability of equipment other
than stethoscope (98 percent) was low. Peak flow meters were only available in 6 percent of the health facilities while
oxygen and spacer for inhalers were in less than 20 percent of the facilities.
Hydrocortisone and Epinephrine injectable were reported to be the most commonly available medicines found in 80
percent and 81 percent of the health facilities respectively. Beclomethasone used for the treatment of asthma was less
available in health facilities. Only 7 percent of health facilities assessed reported to have the medication.
Peak flow meters used to detect pulmonary for asthma patients was available in only a quarter (25 percent) of the
hospitals assessed. Epinephrine injectable was universally available in hospitals. Rural health facilities were also more
likely (87 percent) to have this commodity compared to urban facilities (71 percent). Salbutamol inhaler was found
more in hospitals than in other levels of care, similarly in private health facilities (NGO/not for profit 51 percent, private
for profit, 50 percent, mission 42 percent and parastatals 60 percent) compared to government of public health
facilities.

62
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Guideline available CRD diagnosis and management 44%
At least 1 trained staff CRD diagnosis and treatment 23%
Stethoscope 98%
Oxygen 18%
Peak flow meter 6%
Spacers for inhalers 19%
Hydrocortisone 80%
Beclomethasone inhaler 7%
Epinephrine injectable 81%
Salbutamol inhaler 34%
Prednisolone 54%
Mean availability of tracer items 42%
Percent of facilities with all items 0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability
Staff and Guidelines Equipment Medicines and Commodities Readiness Score

FIGURE 14.3
Percentage of facilities that have tracer items for chronic respiratory disease services among
facilities that provide this service (n=295)

Cervical cancer

Health facilities offering diagnosis of cervical cancer were 11 percent of the 549 assessed. These services were mostly
available in hospitals (69 percent) which are probably managed by NGO/not-for-profit (20 percent) or private for
profit (23 percent) health facilities.

Offers cervical cancer diagnosis Total number of facilities

Facility type
Hospital 69% 53
Health Center 41% 152
Dispensary 5% 344
Managing authority
Government/public 9% 254
NGO/not-for-profit 20% 17
Private-for-profit 23% 126
Mission/faith based 18% 149
Parastatal 0% 3
Urban/Rural
Rural 9% 328
Urban 17% 221
Total 11% 549

TABLE 14.4
Percentage of facilities that offer cervical cancer services (N=549)

63
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 SERVICE READINESS

Out of the 549 health facilities, 127 (28 percent) assessed, reported to offer cervical cancer services. The mean
availability of tracer items for cervical cancer services was 71 percent. The availability of speculum device was high
(97 percent). This is a device used for visual inspection of the vagina and cervix, as well as a way to collect the cervical
cells necessary for a Pap smear test. Almost three quarters (72 percent) of health facilities reported to have at least
one staff trained in diagnosis cervical cancer.
Guidelines for cervical cancer prevention and control were available in almost half (47 percent) of all health facilities.
Guidelines were more likely to be found in hospitals (73 percent) and in NGO/not-for-profit health facilities (80
percent).
Acetic acid was one of the commodities that was available in more than two thirds (69 percent) of the health facilities
assessed. Availability of acetic acid varied from 49 percent in dispensaries to 93 percent in hospitals, and from 42
percent in private for profit to 100 percent in NGO/not-for-profit.

Total number of facilities

Percent of facilities with
Staff trained in cervical
cancer prevention and

cancer prevention and

Guidelines for cervical

Mean availability of
tracer items
Acetic acid
Speculum

all items
control

control

Facility type
Hospital 73% 92% 94% 93% 63% 88% 38
Health Center 44% 78% 98% 73% 30% 73% 62
Dispensary 33% 53% 98% 49% 29% 58% 27
Managing authority
Government/public 48% 79% 97% 71% 36% 74% 68
NGO/not-for-profit 80% 100% 100% 100% 80% 95% 6
Private-for-profit 28% 42% 96% 42% 22% 52% 26
Mission/faith based 56% 80% 97% 87% 51% 80% 27
Parastatal N/A N/A N/A N/A N/A N/A 0
Urban/Rural
Rural 49% 75% 98% 68% 40% 72% 73
Urban 44% 69% 96% 71% 34% 70% 54
Total 47% 72% 97% 69% 38% 71% 127

TABLE 14.5
Percentage of facilities that have tracer items for cervical cancer services among facilities that
provide this service (n-127)

64
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
SURGICAL
SERVICES

15
 Surgical services at the primary care level are an essential component of comprehensive primary healthcare, whereas
more comprehensive surgical care requiring a well-equipped operating theatre is generally performed only at the
district hospital level or above. Poor access to surgical services, particularly at rural facilities, results in excess
morbidity and mortality from a broad range of treatable surgical conditions including injuries, complications of
pregnancy, sequelae of infectious diseases, acute abdominal conditions and congenital anomalies. Although the rural
population accounts for over 70 percent of the population in Tanzania, many hospitals across the country have no
permanent surgical or medical specialists, anesthesiologists, and/or healthcare workers with formal specialty training
in emergency or critical care.

The Lancet Commission on Global Surgery estimates that at least 20-40 surgical specialists are needed per 100,000
population. Tanzania’s density of specialist surgical workforce is 0.31 physician surgeons, obstetricians and
anesthesiologists per 100,000 population. In 2017, the MOHCDGEC partnered with GE Foundation and Safe Surgery
2020 to work on a strategic plan to transform surgical services in the country.

Improving access to surgical services in low-income countries requires a systems-based approach to address gaps in
infrastructure, trained/skilled personnel, appropriate equipment and medications. The SARA 2017 survey included
assessments for both basic and comprehensive surgical care.

15.1 BASIC SURGERY SERVICES

Improving the provision of good quality surgical services particularly at the primary healthcare facility level is an
increasingly recognized priority. We are observing efforts by the MOHCDGEC being directed at improving day-to-day
practice, training, and policy decisions surrounding surgical care with the ultimate aim of reducing death and
disability.

SERVICE AVAILABILITY

Figure 18.1 shows the percentage of facilities offering basic surgery services by facility type, by managing authority,
and by urban/rural. Basic surgical services were available in 72 percent of the health facilities assessed.
The most commonly available services were incision and drainage of abscesses (71 percent), suturing (72 percent),
wound debridement (72 percent) and acute burn management (65 percent). All hospitals assessed reported to offer
surgical services as well incision and drainage of abscesses and wound debridement service.

Closed repair of fracture was available in 10 percent of health facilities and these were mostly hospitals (77 percent).
Four out of ten (40 percent) health facilities offered male circumcision services. Services ranged from 35 percent in
dispensaries to 88 percent in hospitals and from 27 percent in parastatal health facilities to 94 percent in
NGO/not-for-profit.

Four basic surgical services had an overall availability of less than 5 percent and these mostly offered at hospitals.
Cricothyroidectomy, was offered in 31 percent of hospitals, while chest tube insertion was offered in 59 percent of
hospitals, biopsy of the lymph node was available in 61 percent while hydrocele reduction was in offered in 85 percent
of the hospitals.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Offers basic surgical services 72%
Incision and drainage of abscesses 71%
Suturing 72%
Wound debridement 72%
Acute burn management 65%
Male circumcision 40%
Closed repair of fracture 10%
Hydrocele reduction 5%
Biopsy of lymph node or mass or other 3%
Chest tube insertion 3%
Closed repair of dislocated joint 14%
Removal of foreign body 54%
Cricothyroidotomy 2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability

FIGURE 15.1
Percentage of facilities that offer basic surgical services

SERVICE READINESS

Out of the 549 health facilities assessed for availability of surgical services, 433 health facilities reported to have basic
surgical services available. The mean availability of tracer items for basic surgical services was 39 percent. Staff and
guidelines were the least available tracer items. Only 6 percent of health facilities reported to have integrated
management for emergency and essential surgical care (IMEESC) guidelines and at least one staff trained on IMEESC.

Needle holders (88 percent), surgical scissors (77 percent) and scalpel handle with blade (57 percent) were the most
available equipment. There were not huge variations in the availability of the needle holders and surgical scissors
across facility type, managing authority and in urban/rural health facilities. Retractors were more likely to be found in
hospitals (83 percent) than in lower facilities, health centre (43 percent) and dispensary (3 percent).

Availability of medicines and commodities was high above 80 percent, except for ketamine injectable (10 percent),
materials for cast (12 percent) and splints for extremities (4 percent) which were mostly found in hospitals.

67
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Guidelines available IMEESC* 6%
At least 1 trained staff IMEESC* 6%
Needle holder 88%
Surgical scissors 71%
Tourniquet 36%
Scalpel handle with blade 57%
Retractor 12%
Suction apparatus 26%
Nasogastric tubes 17%
Oxygen 9%
Adult and paediatric resuscitators 29%
Skin disinfectant 97%
Lidocaine (1% or 2% injectable) 82%
Material for cast 12%
Ketamine (injectable) 10%
Sutures 95%
Splints for extremities 4%
Mean availability of tracer items 39%
Percent of facilities with all items 1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability
Staff and Guidelines Equipment Medicines and Commodities Readiness Score

FIGURE 15.2
Percentage of facilities that have tracer items for basic surgical services among facilities that provide this service

15.2 COMPREHENSIVE SURGICAL SERVICES

Hospitals have the capacity to provide a wider and more comprehensive range of surgical care compared to health
centers and dispensaries. We also assessed the capacity of hospitals to offer comprehensive surgical services in
addition to the basic surgical interventions covered in the section above.

SERVICE AVAILABILITY

Figure 15.3 shows the percentage of comprehensive surgery services offered by the 53 hospitals assessed in the
SARA 2017. Comprehensive surgery services that were most available in the hospitals were episiotomy (77 percent),
appendectomy (76 percent), hernia repair elective and strangulated (76 percent), dilation and curettage (74 percent),
tubal ligation (71 percent), congenital hernia repair (70 percent) and cystostomy (69 percent). Cleft palate was the
least offered surgical services with only 15 percent of the hospitals providing the service.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Offers comprehensive surgical services 100%
Appendectomy 76%
Congenital hernia repair 70%
Hernia repair (elective) 76%
Hernia repair (strangulated) 76%
Laparotomy 76%
Tubal ligation 71%
Urethral stricture dilatation 46%
Amputation 59%
Cataract surgery 23%
Club foot repair 31%
Cystostomy 69%
Drainage of osteomyelitis-septic arthritis 48%
Episiotomy 77%
Obstetric fistula repair 25%
Open reduction and fixation for fracture 31%
Vasectomy 55%
Neonatal surgery 29%
Cleft palate 15%
Dilatation and Curettage 74%
Skin grafting and Contracture release 30%
Tracheostomy 33%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability
!"#$%&$'($)*+,-&$%&.,-&#,%/$+*0% ,'012
FIGURE 15.3
Percentage of hospitals that offer comprehensive surgical services

SERVICE READINESS

Figure 17.4 shows the percentage of hospitals that have tracer items for comprehensive surgical services among
facilities that provide this service. A total of 53 hospital assessed for availability of comprehensive surgical services
were also assessed for their readiness to provide this services.

The mean availability of tracer items for provision of comprehensive surgical services was 65 percent. Most hospitals
had staff trained in anaesthesia (83 percent) and in surgery (83 percent), however, availability of materials on IMEESC
and having at least one staff trained on IMEESC was 30 percent and 40 percent respectively.

Most facilities had the requisite equipment to carry out comprehensive surgical services. Oxygen necessary during
operations was available in 72 percent of the hospitals, suction apparatus (82 percent) and spinal needle in 73 percent
of the hospitals. Only one third (33 percent) of the hospitals had anaesthesia equipment. Lack of this equipment can
be challenging in conducting some of surgical procedures.

Medicines and commodities were reasonably available in hospitals. More than half of the hospitals reported to have
these items with the exception of Lidocaine 5% which was reported in 44 percent of the hospital.

In general, non-government hospitals were slightly better of than government hospitals in staffing and guidelines,
equipment and medicines and commodities for comprehensive surgical services.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 Materials available IMEESC* 30%
Staff trained in anaesthesia 83%
Staff trained in surgery 83%
At least 1 trained staff IMEESC* 40%
Oxygen 72%
Spinal needle 73%
Suction apparatus 82%
Anaesthesia equipment 33%
Atropine (injectable) 77%
Bupivacaine (injectable) 65%
Diazepam (injectable) 88%
Ephedrine (injectable) 66%
Epinephrine (injectable) 100%
Halothane (inhalation) 61%
Lidocaine 5% (heavy spinal solution) 44%
Suxamethonium bromide (powder) 56%
Thiopental (powder) 52%
Mean availability of tracer items 65%
Percent of facilities with all items 5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability
!"#$%&$'($)*+,-&$%&.,-&#,%/$+*0%&,'012

Staff and Guidelines Equipment Medicines and Commodities Readiness Score

FIGURE 15.4
Percentage of hospitals that have tracer items for comprehensive surgical services among
facilities that provide this service

15.3 BLOOD TRANSFUSION

The availability of safe blood and blood products is one of the government’s strategies to combat the spread of HIV
infection and elimination of transmission though transfusion. Currently, blood transfusion services in Tanzania are
decentralized and normally not available at lower level health facilities (below district hospitals). Manpower, adequate
infrastructure and financial capability are some of the challenges hindering the provision of blood transfusion
services.

Offers blood transfusion Total number of facilities

Facility type
Hospital 85% 53
Health Centers 19% 152
Dispensary 0% 344
Managing authority
Government/public 3% 254
NGO/not-for-profit 25% 17
Private-for-profit 9% 126
Mission/faith based 13% 149
Parastatal 0% 3
Urban/Rural
Rural 5% 328
Urban 7% 221
Total 5% 549

TABLE 15.1
Percentage of facilities that offer blood transfusion services (N=549)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 This survey assessed the capacity of staff, availability of guidelines for blood transfusion and procedures followed
before blood transfusion for each facility providing blood transfusion services.

SERVICE AVAILABILITY

Only 5 percent of the 549 health facilities visited offered blood transfusion services. 85 percent of survey hospitals
offered the service, 19 percent of health centers while none of the dispensaries offered blood transfusion services.
NGO/Not for profit facilities were more likely to offer blood transfusion services compared to either government or
private-for-profit providers (possibly due to sample composition) but the distribution was very similar in rural and
urban settings.

SERVICE READINESS

Table 17.2 shows the percentage of facilities that had tracer items for blood transfusion among facilities that provide
the service. A total of 79 hospitals assessed for readiness to provide blood transfusion services.
The readiness score to provide blood transfusion services was 65%. Approximately four out of ten (43 percent)
facilities that offered blood transfusion had guidelines available. Blood typing services was high (95 percent) and
available in hospitals and health centers, whereas cross-match typing was available in just over half (54 percent) of
the health facilities. Two thirds (68 percent) of health facilities had blood storage refrigerator.
and safe blood transfusion

Blood storage refrigerator

Mean availability of tracer

appropriate use of blood

appropriate use of blood

Blood supply sufficiency

Percent of facilities with

and blood transfusion

At least 1 trained staff

Guidelines available

Blood supply safety

Cross match typing

Total number of
Blood typing

all items

facilities
items

Facility type
Hospital 50% 72% 77% 97% 70% 53% 82% 13% 71% 49
Health Center 33% 26% 52% 91% 26% 55% 90% 0% 53% 30
Dispensary N/A N/A N/A N/A N/A N/A N/A N/A N/A 0
Managing authority
Government/public 33% 54% 61% 89% 46% 52% 88% 6% 60% 34
NGO/not-for-profit 43% 51% 49% 100% 49% 41% 76% 8% 58% 7
Private-for-profit 26% 45% 73% 100% 73% 76% 91% 11% 69% 19
Mission/faith based 73% 62% 83% 100% 57% 47% 80% 12% 72% 19
Parastatal N/A N/A N/A N/A N/A N/A N/A N/A N/A 0
Urban/Rural
Rural 49% 59% 71% 93% 46% 50% 86% 7% 65% 48
Urban 32% 46% 62% 100% 70% 62% 82% 12% 65% 31
Total 43% 55% 68% 95% 54% 54% 85% 8% 65% 79

TABLE 15.2
Percentage of facilities that have tracer items for blood transfusion services among facilities
that provide this service (n=79)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
DIAGNOSTICS

16
 Advanced diagnostic services was assessed at hospital settings only and this refers to the capability of hospitals to
provide the following diagnostic tests
•Gram stain
•Syphilis serology
•Liver function test
•Renal function test
•Cryptococcal antigen
•Blood typing (ABO and Rhesus) and cross match (by anti-globulin or equivalent)
•CD4 count and percentage
•Full blood count with differential
•Serum electrolytes
•CSF/body fluid counts
•HIV antibody testing (ELISA)
•Urine dipstick with microscopy

Mean availabitlity of tracer items 50%

Gram stain 48%

Syphilis serology 57%

Liver function test 49%

Renal function test 48%

Cryptococcal antigen 45%

Blood typing (ABO and Rhesus) and cross match (by anti- 60%
globulin or equivalent)
CD4 count and percentage 68%

Full blood count with differential 46%

Serum electrolytes 13%

CSF/body fluid counts 44%

HIV antibody testing (ELISA) 66%

Urine dipstick with microscopy 60%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage availability
!"#$%&$'($)*+,-&$%&.,-#,%/$+*0%&,'012

TABLE 16.1
Percentage of hospitals with advanced diagnostic capacity (n=53)

The mean availability of tracer items for advance diagnostic capacity was 50 percent for the 53 hospitals assessed.
A closer examination of the diagnostics test available (Table 16.2) reveals that over half of the hospitals offered CD4
count, HIV antibody testing (ELISA), Syphilis serology and urine dipstick with microscopy. The lowest available
advanced diagnostic test in the hospital setting was serum electrolytes (13%), which was only available in urban
hospitals.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 74
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 (BY ANTI-GLOBULIN OR

(BY ANTI-GLOBULIN OR
RENAL FUNCTION TEST

RENAL FUNCTION TEST

SERUM ELECTROLYTES

SERUM ELECTROLYTES

LIVER FUNCTION TEST

BLOOD TYPING (ABO

BLOOD TYPING (ABO

FULL BLOOD COUNT

FULL BLOOD COUNT

WITH DIFFERENTIAL

WITH DIFFERENTIAL
AND RHESUS) AND

AND RHESUS) AND

CD4 COUNT AND

CROSS MATCH

CROSS MATCH

PERCENTAGE
EQUIVALENT)

EQUIVALENT)
Facility type Facility type
Hospital 13% Hospital 46% 60% 13% 48% 46% 49% 60% 68% 48%
Managing authority Managing authority
Government/public 4% Government/public
31% 46% 4% 38% 31% 38% 46% 62% 38%
NGO/not-for-profit 13% NGO/not-for-profit
50% 75% 13% 50% 50% 50% 75% 62% 50%
Private-for-profit 54% Private-for-profit
85% 85% 54% 83% 85% 83% 85% 39% 83%
Mission/faith based 7% Mission/faith
46% based 63% 7% 46% 46% 49% 63% 89% 46%
Parastatal Parastatal
Urban/Rural Urban/Rural
Rural 0% Rural 38% 53% 0% 41% 38% 41% 53% 75% 41%
Urban 46% Urban 64% 76% 46% 65% 64% 69% 76% 50% 65%
Total 13% Total 46% 60% 13% 48% 46% 49% 60% 68% 48%

TABLE 16.2
Percentage of hospitals that offer advanced diagnostic services (n=53)
TABLE 16.2
Percentage of hospitals that offer advanced diagnostic services (n=53)

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
 HIV ANTIBODY TESTING

URINE DIPSTICK WITH

URINE DIPSTICK WITH

MEAN AVAILABITLITY

MEAN AVAILABITLITY
SYPHILIS SEROLOGY

TOTAL NUMBER OF

TOTAL NUMBER OF
OF TRACER ITEMS

OF TRACER ITEMS
CSF/BODY FLUID

CSF/BODY FLUID
CRYPTOCOCCAL
MICROSCOPY

MICROSCOPY
GRAM STAIN

GRAM STAIN

FACILITIES

FACILITIES
ANTIGEN

ANTIGEN

COUNTS

COUNTS
(ELISA)

% 66% 48% 57% 60% 45% 44% 48% 50% 60% 53 44% 50% 53

% 55% 55% 51% 67% 48% 41% 55% 45% 67% 18 41% 45% 18
% 38% 25% 50% 25% 62% 13% 25% 43% 25% 5 13% 43% 5
% 93% 39% 63% 61% 32% 46% 39% 64% 61% 12 46% 64% 12
0% 76% 48% 65% 59% 40% 55% 48% 54% 59% 18 55% 54% 18
0 0

% 57% 48% 48% 60% 47% 43% 48% 46% 60% 32 43% 46% 32
% 89% 47% 81% 59% 39% 47% 47% 61% 59% 21 47% 61% 21
% 66% 48% 57% 60% 45% 44% 48% 50% 60% 53 44% 50% 53

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
CONCLUSION

17
The service availability and readiness assessment (SARA) 2017 report provides a snapshot of services availability and
readiness in Tanzania. This is the second time Tanzania has conducted SARA and hence there a few lessons that have
been learnt from the previous assessment. The information presented in this report complements other data sources
such as the Tanzania Service Provision Assessment (TSPA 2015), TDHS 2015-16 in monitoring coverage and provision
of health care services in both public and private sectors.
Overall service availability in terms of health facilities and core health worker’s density per 10,000 population is still
below the required standards. Although most of the Tanzanian population live within 5km from a health facility, the
population increase in the last two decades has not been commensurate to the increase in core human resources for
health.
The general service readiness (GSR) though has improved from 42 percent in 2012 to 57 percent in 2017. Most
improvement was on the basic amenities mean score which was 27 percent in 2012 and increased to 82 percent in 2016.
Basic equipment and essential medicine mean scores on the other hand were lower in 2016 compared to 2012
Overall, diagnostics capacity for different services was reasonably high. HIV and malaria diagnostic capacity were
almost universal. Other specific diagnostics capacity such as CD4 or viral load that is critical for monitoring viral
suppression, liver and renal function tests were mostly low in lower level facilities. TB microscopy was available in only
one fifth of the facilities which were mostly hospitals and health centers. While the TB program is planning to improve
diagnostic capacity using more accurate high technology such as GeneXpert, more efforts are needed to improve case
detection using microscopy at dispensary level where this is the first point of contact for people
Availability of essential medicines varied across from 90% for ORS to availability of less than 5% for non-communicable
disease medication such as Carbamazepine tablets, ACE inhibitors, and statins. On the other hand, availability of
essential medicines for children was much better compared to the overall availability of essential medicines.
Availability of tracer medicines for infectious diseases was high with the exception of Fluconazole capsules or tablets
which were available in a quarter of health facilities
Availability of health services was generally high. Nine of the sixteen services assessed were available in over 80%
facilities in the surveyed districts. Malaria services were universally available across where HIV and preventive and
curative services were available in nine out of ten facilities surveyed. The high availability of malaria and HIV services
fits well with the heavy investments in the health system by the government and key stakeholders such as the Global
Fund, US government through PEPFAR and PMI programs. The recent reports on HIV and Malaria indicator surveys,
however show opposite directions in the prevalence of the two diseases.
Non-communicable disease such as diabetes, cancer and hypertension are on the increase in most developing
countries including Tanzania. The increase is perpetuated by a number of factors including lifestyle such drinking,
smoking, salt intake and lack of exercise. Availability and readiness of health services are not up to speed to cope with
the increase in chronic conditions. Prevention methods such as health education, law enforcement on banning smoking
in public areas or for under age children, ensuring low salt and sugar in food and beverages are among the measures
that need constant follow up.
Data collection using Android Tablet PCs pre-loaded with the questionnaire that had in-built range and consistency
checks made the speed of fieldwork and data analysis much faster. Coordination of field teams that were split in
different districts was done by creating a WhatsApp group. The group facilitated discussions on the challenges and
successes teams had on a daily basis. This platform also helped in providing solutions to teams in real-time whenever
they encountered challenges
Although we were able to draw the sample of facilities from the health facilities master list, frequent updates of the list
is required as some of the facilities included in the sample were closed for over the past one year. There is also a need
for relevant authorities to categorize health facilities within districts by existing administrative structures for them to
be regarded as either rural or urban facilities.
It should be noted that more that 40% of the health facilities in the sample were operated by the government. Of these,
half were dispensaries. The recent decision by the government to introduce direct health facility financing is expected
to strengthen the delivery of health services at primary health care level. Health facilities will now have more resources
and flexibility to order supplies and commodities in addition to conducting minor repairs as needed.
Findings reported here were confined to estimates at the national level for ownership, facility type and by residence.
Analysis of service availability and readiness at district level will be provided at a later stage as it was beyond the scope
of this report.

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
REFERENCES

18
1. Ministry of Health Community Development Gender Elderly and Children. Health Sector Strategic Plan IV.
Dar es Salaam, Tanzania.

2. United Nations. United Nations. Open Working Group proposal for Sustainable Development Goals.
https://sustainabledevelopment.un.org/content/documents/1579SDGs Proposal.pdf%0A (accessed Feb 8, 2018).

3. MOHCDGEC, MOH, NBS, OCGS and I. Ministry of Health, Community Development, Gender, Elderly and Children
(MOHCDGEC) [Tanzania Mainland], Ministry of Health (MOH) [Zanzibar], National Bureau of Statistics (NBS), Office of
the Chief Government Statistician (OCGS) and ICF. 2016. Tanzania D. Dar es Salaam, Tanzania and Rockville, Maryland
USA, 2016.

4. World Bank. Tanzania-Big Results Now for Health Project. 2014.

http://documents.worldbank.org/curated/en/648601468112497753/Tanzania-Big-Results-Now-for-Health-Project
(accessed Feb 8, 2018).

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SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
FIELD TEAM
CASIAN MPANGALA IHI DAR ES SALAAM
FATUMA MANZI RESEARCH SCIENTIST IHI-DAR ES SALAAM
DAVID MASESA IHI IHI-MOROGORO
KALOLI NTALIMA MO II IHI-BAGAMOYO
ROSEMARY NTALWILA RRCH CO KATAVI
ANTHONY MICHAEL KIKOTI DATA COLLECTOR KIGOMA
ABEL ANTHONY STATISTICIAN DODOMA
MARCELINA MPANDACHALO RRCH CO TABORA
OSCAR EMMANUEL DATA COLLECTOR URAMBO
DAUDI JACOB MARWA ASS.RRCH CO RAS-SIMIYU
CAROLINE MASANJA IHI IHI-DSM
JOYCE KONDORO RRCH CO RAS-SHINYANGA
HASSAN MKOPI DATA COLLECTOR PWANI
LEAH DANIEL RRCH CO MARA
PROCHES NORBERT CO BUKOBA
LUCAS S. MADENI LLT MASWA CATS
ELIAS VICENT IHI IHI-TABORA
MOSHI HABIBU MSANGI IHI IHI-TANGA
PETER TANGO RRCH CO GEITA
EMMANUEL BUTIKU HO ARUSHA
ADRIANA L. KAUMUNDA RRCH CO KAGERA
EMMANUEL MNKENI DATA COLLECTION NBS
RASHID KITUNDU DATA COLLECTOR DAR ES SALAAM
ZEREA M. ETANGA DATA COLLECTION IHI
CRISTOWERU I. BARNABAS RRCH CO RS-SINGIDA
SETH BARANYIKWA HO MWANZA
YUSUFU HAMIDU DATA COLLECTOR IHI
JULIETH J. TESHA RN OCEAN ROAD
JECKONIA EMMANUEL CO TABORA
DR. ADEN MPANGILE RTIC RS-PWANI
DR. MBAROUK SEIF RTLC ILALA
DIANA F. MANG'ANA SONGEA IHI
SARAH LUCUMAY HMIS CO DSM
ELIASHISHI ISRAEL VIKOBIKO H/O NJOMBE
MECKTIDIS MOYO M&E MOHCDGEC
WEMAEL ZACHARIA DATA COLLECTOR DAR ES SALAAM
SHOKO MOHAMED IHI IHI-BAGAMOYO
JOYCE M. GORDEM RRCH CO RS-PWANI
REGINA CHRISTOPPHER RN KIGOMA
ELIAS MAKOYE MOI TTCIH

81
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
FIELD TEAM
SEIF RAMADHANI EN IHI-TANGA
ZAINABU MATHRADAS RRCH CO SOKOINE HOSP
MOHAMMED ABDALLA DATA COLLECTOR LINDI
AGNES MWIYA RN NDANDA HOSP
TAIFA CONSTANTINE DATA COLLECTOR MTWARA
MDOE J. IBRAHIM HRO II TCHRT KCMC
MARYROSE JACOB DATA COLLECTOR DAR ES SALAAM
GISELA J. MTEI IHI IHI-DSM
ALOYCE MALEGE DATA COLLECTOR ARUSHA
ROSEMARY MLAY IHI IHI-DSM
ABDULKARIMU KADHI DATA COLLECTOR LINDI
FATINA RASHID RRCH CO RAS-K/NJARO
STEVEN A. MPAGAMA DSM IHI
GLORY D. DADI DATA COLLECTION PWANI
DANIEL CLEMENCE MGIMBA AG. RRCHCO NJOMBE
CECILIA KILLE AG. RRCHCO SONGWE
CHARLES KAZI DATA COLLECTOR MWANZA
JOYCE MWASHA PHARMACIST DSM
JENIFER CHAMI DATA COLLECTOR DAR ES SALAAM
MARIAM K. MOHAMED RRCH CO IRINGA
JUSTINE JOSEPH IHI IHI-MAFINGA
KIZITO SHIRIMA FACILITATOR IHI-BAGAMOYO
AZIZI AHAMED ALLY FACILITATOR IHI-BAGAMOYO
NEEMA S. GAMASA FACILITATOR IHI-BAGAMOYO
MARY IREMA FACILITATOR IHI-BAGAMOYO
IMANI IREMA FACILITATOR IHI-BAGAMOYO
SELEMANI C. MMBAGA FACILITATOR IHI-BAGAMOYO
FATUMA MANZI DR COORDINATOR & CHIEF SCIENTIST IHI-BAGAMOYO
BEATRICE BILIKWIJA RESEARCH OFFICER IHI-BAGAMOYO
HONORATI MASANJA DG IHI
CHARLE FESTO SCIENTIST IHI
TRUST NYONDO M&E OFFICER MOHCDGEC
WILFRED YOHANA MOH MOHCDGEC
CLAUD KUMAJA AD-M&E MOHCDGEC
ENOCK MHEHE M&E OFFICER MOHCDGEC
LYDIA J. MWAGA M&E MOHCDGEC

82
SERVICE AVAILABILITY AND READINESS ASSESSMENT ( SARA ) DECEMBER | 2017
Ifakara Health Institute
Kiko avenue, Mikocheni B
p. o. box 78373, DSM
Tanzania
www.ihi.or.tz