Integrity Practices and the Performance of Public Health Care: A Case of Mnazimmoja Hospital, Tanzania

Abstract

Integrity, characterized by honesty, adherence to rules, and ethical conduct, is a cornerstone of trust and quality in healthcare delivery. This study assessed the influence of integrity practices on the performance of public health care at Mnazimmoja Hospital in Dar es Salaam, Tanzania. A descriptive cross-sectional design was employed, collecting data from 139 participants, including 83 patients and 56 healthcare staff, using structured questionnaires and in-depth interviews. Quantitative data were analyzed using descriptive statistics (frequencies, percentages, mean, standard deviation), while qualitative data were analyzed thematically. The study revealed a generally positive perception of integrity practices. A majority of patients (58.9%) agreed that observed ethical breaches were addressed promptly (Mean=2.10). Similarly, staff demonstrated a high level of self-reported integrity, with all respondents (100%) affirming they do not misuse hospital resources and follow rules even when unsupervised (67.9% agreed, Mean=1.71). However, significant uncertainty was noted in areas of reporting unethical behavior. Among staff, 60.7% were undecided about reporting a colleague's misconduct, and 58.9% were hesitant to report their own errors, indicating potential fear of retaliation or a lack of psychological safety. While Mnazimmoja Hospital has a strong foundation in rule compliance and resource ethics, critical gaps exist in the systems that support transparency and whistleblowing. To enhance performance and patient trust, the hospital should strengthen its integrity framework by reinforcing whistleblower protection mechanisms, fostering a culture of open disclosure, and enhancing patient awareness of ethical standards.