Table 2. Independent variables, assessment of changes in health facility quality, United Republic of Tanzania, 2015–2020.
| Construct and facility variable | Definition of variable | Data source | Mean (SD)a |
|---|---|---|---|
| Outer setting | |||
| Patient needs and resources | |||
| Population density | No. of people within a 5 km radius of a health facilityb | World population estimates for 201518 | 24 147 (63 733) |
| Population demand for coveragec | Percentage of women in district who gave birth in a facility in the past 5 years | Demographic and Health Survey 201619 | 71 (22) |
| Informed consumersc | Percentage of women in district who completed primary education | Demographic and Health Survey 2016 | 73 (15) |
| Health-care agencyc | Percentage of women in district who were involved in decisions about their own health care | Demographic and Health Survey 2016 | 74 (13) |
| Cosmopolitanism | |||
| Facility densityc | Number of facilities in district per 100 000 population | Star rating assessment 2015 | 15.4 (7.2) |
| Urban councilc | Percentage of facilities in town or municipal council areas and not in rural district council areas | Star rating assessment 2015 | 12 (33) |
| Structural environment | |||
| Accessibility | Distance to major road, in km (bilinear interpolation)b | OpenStreetMap 201620 | 2.32 (4.54) |
| Remoteness | Distance to city with a population of at least 50 000, in 10-km units | Natural Earth II21 | 7.1 (5.1) |
| Peer pressure | |||
| Facility rank at baseline | Percentile rank of facility’s baseline star rating compared with other facilities in the same district | Star rating assessment 2015 | 42 (33) |
| External policies and incentives | |||
| Participated in results-based financing programme | Percentage of facilities that participated in the results-based financing programme | Star rating assessment 2015 | 15 (NA) |
| Ineligible for results-based financing programme | Percentage of facilities that were public facilities in a region participating in the results-based financing programme but had a baseline star rating of zero | Star rating assessment 2015 | 11 (NA) |
| Starter fund | Percentage of facilities in an area eligible for a starter fund that had a baseline star rating of zero | Star rating assessment 2015 | 4 (NA) |
| Inner setting | |||
| Structural characteristics | |||
| Ownership | Percentage of facilities that were public | Star rating assessment 2015 | 81 (NA) |
| Ownership | Percentage of facilities that were private for-profit facilities | Star rating assessment 2015 | 9 (NA) |
| Ownership | Percentage of facilities that were private non-profit facilities | Star rating assessment 2015 | 10 (NA) |
| Level | Percentage of facilities that were dispensaries | Star rating assessment 2015 | 85 (NA) |
| Level | Percentage of facilities that were health centres | Star rating assessment 2015 | 12 (NA) |
| Level | Percentage of facilities that were primary-level hospitals | Star rating assessment 2015 | 3 (NA) |
| Baseline performance | Facility star rating at baseline | Star rating assessment 2015 | 0.81 (0.71) |
| Subsample analysis onlyd | |||
| External policies and incentives | |||
| External supervision | Percentage of facilities visited by an external supervisor in the previous 6 months who used a checklist, discussed facility performance and helped the facility make decisions based on data | Service provision assessment22 2014–2015 | 76 (NA) |
| Structural characteristics | |||
| Human resources | Number of full-time health workers in each facilityb | Service provision assessment 2014–2015 | 8.6 (21.9) |
| Culture | |||
| Routine data use | Percentage of facilities that reported routine use of a quality assurance system | Service provision assessment 2014–2015 | 15 (NA) |
| Client responsiveness | Percentage of facilities with a procedure for reviewing patient feedback | Service provision assessment 2014–2015 | 9 (NA) |
| Community engagement | Percentage of facilities that had a staff–community meeting within the previous 6 months | Service provision assessment 2014–2015 | 64 (NA) |
| Management function | Percentage of facilities that acted after a recent management meeting | Service provision assessment 2014–2015 | 46 (NA) |
NA: not applicable; SD: standard deviation.
a All values are means and standard deviations unless otherwise noted.
b The natural log of this variable was used in the analytical models.
c Council-level variable.
d The subsample analysis included 672 facilities that took part in a service provision assessment between 2014 and 2015.