implementation of comprehensive council health plan: a case of maternal health services in Rukwa region, Tanzania

Abstract

Background: Preparation of Comprehensive Councils Health Plans (CCHP) in Tanzania mainland is well guided with well stipulated guideline and Strategic Health Plans. The government has facilitated the process of preparing CCHPs by introducing the use of planning software and tools. In the implementation of CCHPs interventions, maternal health services have been receiving a considerable amount of support to ensure that the plans are well implemented, and their indictors are achieved each year. Objectives: The main objective of this study was to to assess how Councils in Rukwa region have been able (or not able) to implement the planned CCHP maternal health service interventions Methods: The study employed an exploratory qualitative study. Data collection was conducted through FGDs involving a total of with 41 participants from CHMTs from four councils in Rukwa Region. Data were also collected by reviewing CCHPs documented interventions for 2017/2018 from four councils in Rukwa region. A thematic approach was employed in analyzing the qualitative data obtained from the field. Results: Enabling factors for the implementation of planned CCHP maternal health services interventions in Rukwa region’s councils include: health facility participatory in planning; partner contribution toward maternal health; direct health financing system; centralized web-based planning and reporting software; and, good communication and coordination system. In addition prohibiting factors for the effective implementation of CCHP were identified, namely: limited maternal health interventions at the community level; lack of maternity waiting homes; inadequate specific supportive supervision; limited referral transport facilities; inadequate technical package; late disbursement of funds; limited human resources; limited planning, budgeting and management capacity at HFs level; inadequate monitoring and evaluation; and, low quality and unreliable data at the facility level. The implementers’ opinions on how to improve the implementation of CCHP include: partners’ maternal interventions contribution to the CCHP; community sensitization on maternal health; construction of maternity waiting homes; training of HFs planning team; the use of bylaws at the community and council level to reduce incidents of home delivery; review of guidelines for health plans; health education package at the community; presence of M & E personnel at the council level; and, timely quarterly fund disbursement. Conclusion: In Tanzania, the preparation of CCHPs at the council level is well articulated. Planning for CCHPs has been found to be participatory by all stakeholders in all the councils visited. However, the implementation process at the council level still requires more inclusion and proper implementation of all planned maternal health intervention and capacity building to HFs planning team and HFGCs. Several challenges should be addressed for efficiency and effective implementation of CCHP to achieve the desired indicators. The findings of this study give room for more improvements in CCHPs implementation at the district, regional and