Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive,... more Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informal payments and, especially, from health workers’ perspectives. Consequently, we have explored the characteristics of health workers and facilities influencing informal payments in Tanzania, examining two hypotheses: health workers with power and position in the system are more likely to receive informal payments, and transparency and accountability measures can be bypassed by those who can game the system. We conducted a cross-sectional survey of 432 health workers from 42 public health facilities (hospitals and health centres) in 12 district councils from Pwani and Dar es Salam regions in Tanzania. Our dependent variable was whether the h...
Corruption is a worldwide concern. Within Tanzania, the landmark Warioba report (URT, 1996) confi... more Corruption is a worldwide concern. Within Tanzania, the landmark Warioba report (URT, 1996) confirmed the existence of extensive corruption across all sectors of the country, including in the public health sector where corruption has been reported at almost every stage of care-seeking. Based on an in-depth review of peer reviewed and grey literature, and complemented by key informant discussions with selected health-system stakeholders, this study seeks to deepen our understanding of informal practices amongst frontline public health providers in mainland Tanzania’s health sector, to explore the incentives that give rise to such practices, and to identify current formal and informal accountability and system-strengthening measures. Taken together, this evidence can be used to inform policy and practice in order to constrain such informal practices
Background: The use of supply-side incentives to increase health service utilisation and enhance ... more Background: The use of supply-side incentives to increase health service utilisation and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is a paucity of evidence on the impact of such schemes, their cost-effectiveness, and the process of implementation and potential unintended consequences in these settings. A pay for performance (P4P) programme was introduced in Pwani region of Tanzania in 2011. Methods/design: An evaluation of the programme will be carried out to inform a potential national rollout. A controlled before and after study will examine the effect of the P4P programme on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. Data will be collected from a survey of 75 facilities, 750 patients exiting consultations, over 75 health workers, and 1,500 households of women who delivered in the previous year, in all seven intervention dis...
Final Report of the Joint Learning Initiative on Children and HIV/AIDSThe Joint Learning Initiati... more Final Report of the Joint Learning Initiative on Children and HIV/AIDSThe Joint Learning Initiative on Children and hiv/aids (jlica) gratefully
workers in the context of health workers' dissatisfaction with their pay (Figure 1), notably ... more workers in the context of health workers' dissatisfaction with their pay (Figure 1), notably at dispensary and health centre levels. " P4P helps [workers] to get some money and this motivates them to provide services more efficiently " , District manager " P4P payment motivates me to work [...] " Health worker. There were however important concerns regarding the potential for P4P to create tensions between RCH/non-RCH staff at hospital level due to the differential bonus amount ($30 vs. $4 respectively). P4P targets were also perceived to be too difficult to attain due to current system constraints. " They want us to implement P4P but they did not consider the weaknesses in the system " District Manager. The main constraint included medical supply and drug shortages, and the lack of medically trained staff (Table 3). " The shortage of drugs, this makes us fail…many drugs were not available; malaria pills [IPT] were not available and it is one o...
BACKGROUND: Tanzania’s health system is currently coping with shortages of drugs, supplies and st... more BACKGROUND: Tanzania’s health system is currently coping with shortages of drugs, supplies and staff, and low worker motivation, threatening the achievements of Millennium Development Goals 4 and 5. A P4P pilot designed to improve maternal and newborn health (MNH) service use and quality is currently underway in Pwani region. The scheme provides bonus payments to health workers based on speci c MNH service use indicators. This presentation discusses the effect of P4P on health worker motivation at different levels of care.
An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priori... more An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many east and southern Africa (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), is implementing research to understand the role of facilitators and the barriers to nationwide application of the EHB in resourcing, organising and in accountability on integrated health services. This literature review provides background evidence to inform the case study work and regional dialogue. It compiles evidence from published and public domain literature on EHBs in sixteen ESA countries, including information on the motivations for developing the EHBs; the methods used to develop, define and cost them; how they ar...
of Key Issues This report reviews the key findings from four recent studies: The Poverty and Huma... more of Key Issues This report reviews the key findings from four recent studies: The Poverty and Human Development Reports (PHDR, 2002 and 2003), Tanzania Participatory Poverty Assessment (TzPPA, 2002-03), and the Policy and Service Satisfaction Survey (PSSS, 2003-04). These studies were commissioned by the Research and Analysis Working Group (R&AWG). R&AWG is part of the Poverty Monitoring System (PMS) set up by the Government of Tanzania to monitor the implementation of the Poverty Reduction Strategy (PRS). PRS is currently being revised for a second phase (2004-2009). Along with these four studies, we also review findings from other recent research on poverty in Tanzania. Tanzania was one of the first countries to benefit from Heavily Indebted Poor Country (HIPC) debt relief, following the preparation of the Poverty Reduction Strategy Paper (PRSP). Debt relief and enhanced donor support helped finance the first phase of the PRS (2000-2003), which saw a considerable increase in social...
Universal Health Coverage (UHC) is a right. Landmark commitments to achieving UHC have been made ... more Universal Health Coverage (UHC) is a right. Landmark commitments to achieving UHC have been made by heads of state in many lowand middle-income countries (LMICs), with broad consensus that Primary Health Care (PHC) is the essential foundation for this. UHC – defined in target 3.8 of the Sustainable Development Goal 3 as financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all – is ultimately about political choices. To monitor progress towards achieving UHC, in March 2017, the UN Statistical Commission adopted two indicators: coverage of essential health services and the proportion of households with large expenditures on health as a share of total household consumption or income. The 2019 WHO Monitoring Report reveals a mixed picture on progress towards UHC, with large regional and country variations in service coverage and financial protection. From 2000 to 2017, the UHC service coverage index1 (Hogan et al., 2018) improved from a global average of 45 to 66 (out of 100), reflecting an average annual increase of 2.3% (WHO, 2019: 1–2). However, from 2000 to 2015, the global incidence of catastrophic out-of-pocket (OOP) health spending (>10% of household consumption or income) increased from 9.4% to 12.7% (WHO, 2019: 2) Overall, progress has been greatest in lower income countries, mainly driven by interventions for infectious diseases and, to a lesser extent, for reproductive, maternal, newborn and child health services, with the poorest countries and those affected by conflict lagging far behind. The principle of ‘leaving no one behind’ is central to UHC, but substantial social inequities in health and access to care, and health burdens driven by social determinants, continue to persist within and between countries. Data from 137 LMICs (Kruk et al., 2018) reveal access and quality deficits affecting the health of women, children and adolescents. Further data gaps mean that we know little about who is left behind.
Payment for Performance (P4P) aims to improve provider motivation to perform better, but little i... more Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. We carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later. We examined the effects of P4P on internal accountability mechanisms including management changes, supervision, and priority setting, and external accountability mechanisms including provider responsiveness to patients, and engagement with Health Facility Governing Committees. P4P had some positive effects on internal accountability, with increased timeliness of sup...
In 1982 a suggested methodology for estimating the range and quantities of a limited number of es... more In 1982 a suggested methodology for estimating the range and quantities of a limited number of essential drugs for a population of 10 000 over a 3 month period was reported by Simmonds and Walkeri. This work formed the basis ofthe WHO Emergency Health Kits for refugee populations-e. A number of these kits have been used in a variety of disaster relief operations and in 1986 WHO commissioned an evaluation to determine the utilization, suitability and appropriateness of the kits". The evaluation findings and recommendations have a number of important policy and organizational implications for both recipient governments and donors.
Background: Tanzania's socioeconomic development is challenged by sharp inequities between and wi... more Background: Tanzania's socioeconomic development is challenged by sharp inequities between and within urban and rural areas, and among different socioeconomic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania. Methods: Based on a conceptual framework for building SDH research capacity, a mapping of existing research systems was undertaken between February and June 2012. It involved a review of national policies, strategies and published SDH-related research outputs from 2005 onwards, and 34 in-depth interviews with a range of stakeholders in Tanzania. Results: The conceptualization of SDH varies considerably among stakeholders and their professional background, but with some consensus that it is linked to "inequities" being a consequence of poverty, poor planning, limited attention to basic humanity and citizenship rights, weak governance structures and inefficient use of available resources. Commonly perceived SDH factors include age, income, education, beliefs, cultural norms, gender, occupation, nutritional status, access to health care, access to safe water and sanitation and child bearing practices. SDH research is in its infancy but gaining momentum. In the absence of a specific "SDH portfolio", SDH research is scattered and hidden within disease specific, poverty-related research and research on universal health coverage. Research is mainly externally funded, which has implications on the focus of context specific SDH research, national priorities and transfer to policy. This create mismatch with population and research capacity needs. Conclusion: Most research analysis in the country fails to consider the context specific structural determinants of health and inequities towards a broader understanding of existing vulnerabilities. The challenge is on promoting a culture of critical inter-disciplinary research and analysis that is central to SDH research. Establishing a system to promote collaboration across sectors and strengthen collective capacities for individuals and institutions researching in SDH will augment existing SDH research initiatives and better inform appropriate intersectoral policies towards addressing prevailing health inequities across the country.
The Joint Learning Initiative on Children and HIV and AIDS is an independent, interdisciplinary n... more The Joint Learning Initiative on Children and HIV and AIDS is an independent, interdisciplinary network of policy-makers, practitioners, community leaders, activists, researchers, and people living with HIV, working to improve the well-being of HIV-affected children, their families and communities.
Background: In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is ... more Background: In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is substantial. Information about the underlying social drivers of HIV transmission in couples is critical for the development of structural approaches to HIV prevention, but not readily available. We explored the association between social drivers, practices, and HIV status among stable couples in Ifakara, Tanzania. Design: Using a cross-sectional design, we analyzed data from a sample of 3,988 married or cohabiting individuals, aged 15 years and older from the MZIMA adult health community cohort study of 2013. Sociodemographic factors (sex, income, age, and education), gender norms (perceived acceptability for a wife to ask her partner to use a condom when she knows he is HIV positive), marriage characteristics (being in a monogamous or a polygamous marriage, being remarried), sexual behavior practices (lifetime number of sexual partners and concurrent sexual partners), health system factors (ever used voluntary HIV counseling and testing), and lifestyle patterns (alcohol use) were used to explore the odds of being HIV positive, with 95% confidence intervals. Results: Prevalence of HIV/AIDS was 6.7% (5.9% males and 7.1% females). Gender norms, that is, perception that a woman is not justified to ask her husband to use a condom even when she knows he has a disease (adjusted odds ratio AOR01.51, 95% CI 1.06Á2.17), marital characteristics, that is, being remarried (AOR 01.49, 95% CI 1.08Á2.04), and sexual behavior characteristics, that is, lifetime number of sexual partners (2Á4: AOR01.47, 95% CI 1.02Á2.11; 5': AOR01.61, 95% CI 1.05Á2.47) were the main independent predictors of HIV prevalence. Conclusions: Among married or cohabiting individuals, the key social drivers/practices that appeared to make people more vulnerable for HIV are gender norms, marriage characteristics (being remarried), and sexual behavior practices (lifetime number of sexual partners). Married and cohabiting couples are an important target group for HIV prevention efforts in Tanzania. In addition to individual interventions, structural interventions are needed to address the gender norms, remarriage, and sexual practices that shape differential vulnerability to HIV in stable couples.
Stabilization of metals in contaminated soils using various waste materials has been reported. Al... more Stabilization of metals in contaminated soils using various waste materials has been reported. Alkaline materials (limes, shells, industrial byproducts, etc.), phosphorous (P) containing materials (animal bones, phosphate rock, etc.), organic materials (composts, manures, biochars, etc.) and others (zerovalent iron, zeolite, etc.) were widely evaluated to ensure its effectiveness/applicability of stabilization of metals in soils. Stabilization mechanisms of those materials above were partially revealed, but the related literatures are still lacked and not sufficient for approaching to long-term stability/applicability in the field. The aims of this review are to summarize current knowledge of metal stabilization in contaminated soils using various waste materials and to suggest a direction for future field research.
Pay for performance schemes are increasingly being implemented in low income countries to improve... more Pay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets. 40 in-depth interviews and four focus group discussions were undertaken with health workers, and regional, district and facility managers. Data was collected on work environment characteristics and staff attitudes towards work in the first phase of the implementation of the pilot. A survey of 75 facilities and 101 health workers were carried out to examine facility resourcing, and health worker employment conditions and job satisfaction. Five contextual factors which affect the implementation of P4P were identified by health workers: salary and employment benefits; resource availability, including staff, medicines and functioning equipment;...
Interest in abortion research is reemerging, partly as a result of political changes and partly d... more Interest in abortion research is reemerging, partly as a result of political changes and partly due to evidence of the contribution of induced abortion to maternal mortality in developing countries. Information is lacking on all aspects of induced abortion, particularly methodological issues. This article reviews the methodological dilemmas encountered in previous studies, which provide useful lessons for future research on induced abortion and its complications, including related deaths. Adverse health outcomes of induced abortion are emphasized, because these are largely avoidable with access to safe abortion services. The main sources of information are examined, and their relevance for assessing rates of induced abortion, complications, and mortality is addressed. Two of the major topics are the problems of identifying cases of induced abortion, abortion complications, and related deaths, and the difficulties of selecting a valid and representative sample of women having the outcome of interest, with an appropriate comparison group. The article concludes with a discussion of approaches for improving the accuracy, completeness, and representativeness of information on induced abortion. Although the prospects for high-quality information seem daunting, it is essential that methodological advances accompany program efforts to alleviate this important public health problem.
This is an exhaustive survey by this committed project for women's dignity. The women are concern... more This is an exhaustive survey by this committed project for women's dignity. The women are concerned primarily for the problem of fistula, but the survey covers all aspects of health services for poor women. The report concludes with 7 points for reflection and action. Here are the contents, the executive summary, the conclusions, and the bibliography. For the whole document go to http://www.womensdignity.org/Peoples_experience.pdf JK Poor people s experiences of health services in Tanzania: A literature review Contents.
International Journal of Gynecology & Obstetrics, 1993
AbStIWt A. Introduction Maternal tetanus, defined as tetanus occurring during pregnancy or within... more AbStIWt A. Introduction Maternal tetanus, defined as tetanus occurring during pregnancy or within 6 weeks after any type of pregnancy termination, is one of the most easily preventable causes of maternal mortality. It includes postpartum or puerperal tetanus resulting from septic procedures during delivery, postabortal tetanus resulting from septic abortion and tetanus incidental to pregnancy, resulting from any type of wound during pregnancy. This review of published and unpublished hospital and community studies concludes that between 15 000 and 30 000 cases of maternal tetanus occur each year. Complete coverage of reproductive-aged women by tetanus toxoid is the most cost-effective way to eliminate this often neglected cause of maternal death.
Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive,... more Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informal payments and, especially, from health workers’ perspectives. Consequently, we have explored the characteristics of health workers and facilities influencing informal payments in Tanzania, examining two hypotheses: health workers with power and position in the system are more likely to receive informal payments, and transparency and accountability measures can be bypassed by those who can game the system. We conducted a cross-sectional survey of 432 health workers from 42 public health facilities (hospitals and health centres) in 12 district councils from Pwani and Dar es Salam regions in Tanzania. Our dependent variable was whether the h...
Corruption is a worldwide concern. Within Tanzania, the landmark Warioba report (URT, 1996) confi... more Corruption is a worldwide concern. Within Tanzania, the landmark Warioba report (URT, 1996) confirmed the existence of extensive corruption across all sectors of the country, including in the public health sector where corruption has been reported at almost every stage of care-seeking. Based on an in-depth review of peer reviewed and grey literature, and complemented by key informant discussions with selected health-system stakeholders, this study seeks to deepen our understanding of informal practices amongst frontline public health providers in mainland Tanzania’s health sector, to explore the incentives that give rise to such practices, and to identify current formal and informal accountability and system-strengthening measures. Taken together, this evidence can be used to inform policy and practice in order to constrain such informal practices
Background: The use of supply-side incentives to increase health service utilisation and enhance ... more Background: The use of supply-side incentives to increase health service utilisation and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is a paucity of evidence on the impact of such schemes, their cost-effectiveness, and the process of implementation and potential unintended consequences in these settings. A pay for performance (P4P) programme was introduced in Pwani region of Tanzania in 2011. Methods/design: An evaluation of the programme will be carried out to inform a potential national rollout. A controlled before and after study will examine the effect of the P4P programme on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. Data will be collected from a survey of 75 facilities, 750 patients exiting consultations, over 75 health workers, and 1,500 households of women who delivered in the previous year, in all seven intervention dis...
Final Report of the Joint Learning Initiative on Children and HIV/AIDSThe Joint Learning Initiati... more Final Report of the Joint Learning Initiative on Children and HIV/AIDSThe Joint Learning Initiative on Children and hiv/aids (jlica) gratefully
workers in the context of health workers' dissatisfaction with their pay (Figure 1), notably ... more workers in the context of health workers' dissatisfaction with their pay (Figure 1), notably at dispensary and health centre levels. " P4P helps [workers] to get some money and this motivates them to provide services more efficiently " , District manager " P4P payment motivates me to work [...] " Health worker. There were however important concerns regarding the potential for P4P to create tensions between RCH/non-RCH staff at hospital level due to the differential bonus amount ($30 vs. $4 respectively). P4P targets were also perceived to be too difficult to attain due to current system constraints. " They want us to implement P4P but they did not consider the weaknesses in the system " District Manager. The main constraint included medical supply and drug shortages, and the lack of medically trained staff (Table 3). " The shortage of drugs, this makes us fail…many drugs were not available; malaria pills [IPT] were not available and it is one o...
BACKGROUND: Tanzania’s health system is currently coping with shortages of drugs, supplies and st... more BACKGROUND: Tanzania’s health system is currently coping with shortages of drugs, supplies and staff, and low worker motivation, threatening the achievements of Millennium Development Goals 4 and 5. A P4P pilot designed to improve maternal and newborn health (MNH) service use and quality is currently underway in Pwani region. The scheme provides bonus payments to health workers based on speci c MNH service use indicators. This presentation discusses the effect of P4P on health worker motivation at different levels of care.
An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priori... more An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many east and southern Africa (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), is implementing research to understand the role of facilitators and the barriers to nationwide application of the EHB in resourcing, organising and in accountability on integrated health services. This literature review provides background evidence to inform the case study work and regional dialogue. It compiles evidence from published and public domain literature on EHBs in sixteen ESA countries, including information on the motivations for developing the EHBs; the methods used to develop, define and cost them; how they ar...
of Key Issues This report reviews the key findings from four recent studies: The Poverty and Huma... more of Key Issues This report reviews the key findings from four recent studies: The Poverty and Human Development Reports (PHDR, 2002 and 2003), Tanzania Participatory Poverty Assessment (TzPPA, 2002-03), and the Policy and Service Satisfaction Survey (PSSS, 2003-04). These studies were commissioned by the Research and Analysis Working Group (R&AWG). R&AWG is part of the Poverty Monitoring System (PMS) set up by the Government of Tanzania to monitor the implementation of the Poverty Reduction Strategy (PRS). PRS is currently being revised for a second phase (2004-2009). Along with these four studies, we also review findings from other recent research on poverty in Tanzania. Tanzania was one of the first countries to benefit from Heavily Indebted Poor Country (HIPC) debt relief, following the preparation of the Poverty Reduction Strategy Paper (PRSP). Debt relief and enhanced donor support helped finance the first phase of the PRS (2000-2003), which saw a considerable increase in social...
Universal Health Coverage (UHC) is a right. Landmark commitments to achieving UHC have been made ... more Universal Health Coverage (UHC) is a right. Landmark commitments to achieving UHC have been made by heads of state in many lowand middle-income countries (LMICs), with broad consensus that Primary Health Care (PHC) is the essential foundation for this. UHC – defined in target 3.8 of the Sustainable Development Goal 3 as financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all – is ultimately about political choices. To monitor progress towards achieving UHC, in March 2017, the UN Statistical Commission adopted two indicators: coverage of essential health services and the proportion of households with large expenditures on health as a share of total household consumption or income. The 2019 WHO Monitoring Report reveals a mixed picture on progress towards UHC, with large regional and country variations in service coverage and financial protection. From 2000 to 2017, the UHC service coverage index1 (Hogan et al., 2018) improved from a global average of 45 to 66 (out of 100), reflecting an average annual increase of 2.3% (WHO, 2019: 1–2). However, from 2000 to 2015, the global incidence of catastrophic out-of-pocket (OOP) health spending (>10% of household consumption or income) increased from 9.4% to 12.7% (WHO, 2019: 2) Overall, progress has been greatest in lower income countries, mainly driven by interventions for infectious diseases and, to a lesser extent, for reproductive, maternal, newborn and child health services, with the poorest countries and those affected by conflict lagging far behind. The principle of ‘leaving no one behind’ is central to UHC, but substantial social inequities in health and access to care, and health burdens driven by social determinants, continue to persist within and between countries. Data from 137 LMICs (Kruk et al., 2018) reveal access and quality deficits affecting the health of women, children and adolescents. Further data gaps mean that we know little about who is left behind.
Payment for Performance (P4P) aims to improve provider motivation to perform better, but little i... more Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. We carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later. We examined the effects of P4P on internal accountability mechanisms including management changes, supervision, and priority setting, and external accountability mechanisms including provider responsiveness to patients, and engagement with Health Facility Governing Committees. P4P had some positive effects on internal accountability, with increased timeliness of sup...
In 1982 a suggested methodology for estimating the range and quantities of a limited number of es... more In 1982 a suggested methodology for estimating the range and quantities of a limited number of essential drugs for a population of 10 000 over a 3 month period was reported by Simmonds and Walkeri. This work formed the basis ofthe WHO Emergency Health Kits for refugee populations-e. A number of these kits have been used in a variety of disaster relief operations and in 1986 WHO commissioned an evaluation to determine the utilization, suitability and appropriateness of the kits". The evaluation findings and recommendations have a number of important policy and organizational implications for both recipient governments and donors.
Background: Tanzania's socioeconomic development is challenged by sharp inequities between and wi... more Background: Tanzania's socioeconomic development is challenged by sharp inequities between and within urban and rural areas, and among different socioeconomic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania. Methods: Based on a conceptual framework for building SDH research capacity, a mapping of existing research systems was undertaken between February and June 2012. It involved a review of national policies, strategies and published SDH-related research outputs from 2005 onwards, and 34 in-depth interviews with a range of stakeholders in Tanzania. Results: The conceptualization of SDH varies considerably among stakeholders and their professional background, but with some consensus that it is linked to "inequities" being a consequence of poverty, poor planning, limited attention to basic humanity and citizenship rights, weak governance structures and inefficient use of available resources. Commonly perceived SDH factors include age, income, education, beliefs, cultural norms, gender, occupation, nutritional status, access to health care, access to safe water and sanitation and child bearing practices. SDH research is in its infancy but gaining momentum. In the absence of a specific "SDH portfolio", SDH research is scattered and hidden within disease specific, poverty-related research and research on universal health coverage. Research is mainly externally funded, which has implications on the focus of context specific SDH research, national priorities and transfer to policy. This create mismatch with population and research capacity needs. Conclusion: Most research analysis in the country fails to consider the context specific structural determinants of health and inequities towards a broader understanding of existing vulnerabilities. The challenge is on promoting a culture of critical inter-disciplinary research and analysis that is central to SDH research. Establishing a system to promote collaboration across sectors and strengthen collective capacities for individuals and institutions researching in SDH will augment existing SDH research initiatives and better inform appropriate intersectoral policies towards addressing prevailing health inequities across the country.
The Joint Learning Initiative on Children and HIV and AIDS is an independent, interdisciplinary n... more The Joint Learning Initiative on Children and HIV and AIDS is an independent, interdisciplinary network of policy-makers, practitioners, community leaders, activists, researchers, and people living with HIV, working to improve the well-being of HIV-affected children, their families and communities.
Background: In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is ... more Background: In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is substantial. Information about the underlying social drivers of HIV transmission in couples is critical for the development of structural approaches to HIV prevention, but not readily available. We explored the association between social drivers, practices, and HIV status among stable couples in Ifakara, Tanzania. Design: Using a cross-sectional design, we analyzed data from a sample of 3,988 married or cohabiting individuals, aged 15 years and older from the MZIMA adult health community cohort study of 2013. Sociodemographic factors (sex, income, age, and education), gender norms (perceived acceptability for a wife to ask her partner to use a condom when she knows he is HIV positive), marriage characteristics (being in a monogamous or a polygamous marriage, being remarried), sexual behavior practices (lifetime number of sexual partners and concurrent sexual partners), health system factors (ever used voluntary HIV counseling and testing), and lifestyle patterns (alcohol use) were used to explore the odds of being HIV positive, with 95% confidence intervals. Results: Prevalence of HIV/AIDS was 6.7% (5.9% males and 7.1% females). Gender norms, that is, perception that a woman is not justified to ask her husband to use a condom even when she knows he has a disease (adjusted odds ratio AOR01.51, 95% CI 1.06Á2.17), marital characteristics, that is, being remarried (AOR 01.49, 95% CI 1.08Á2.04), and sexual behavior characteristics, that is, lifetime number of sexual partners (2Á4: AOR01.47, 95% CI 1.02Á2.11; 5': AOR01.61, 95% CI 1.05Á2.47) were the main independent predictors of HIV prevalence. Conclusions: Among married or cohabiting individuals, the key social drivers/practices that appeared to make people more vulnerable for HIV are gender norms, marriage characteristics (being remarried), and sexual behavior practices (lifetime number of sexual partners). Married and cohabiting couples are an important target group for HIV prevention efforts in Tanzania. In addition to individual interventions, structural interventions are needed to address the gender norms, remarriage, and sexual practices that shape differential vulnerability to HIV in stable couples.
Stabilization of metals in contaminated soils using various waste materials has been reported. Al... more Stabilization of metals in contaminated soils using various waste materials has been reported. Alkaline materials (limes, shells, industrial byproducts, etc.), phosphorous (P) containing materials (animal bones, phosphate rock, etc.), organic materials (composts, manures, biochars, etc.) and others (zerovalent iron, zeolite, etc.) were widely evaluated to ensure its effectiveness/applicability of stabilization of metals in soils. Stabilization mechanisms of those materials above were partially revealed, but the related literatures are still lacked and not sufficient for approaching to long-term stability/applicability in the field. The aims of this review are to summarize current knowledge of metal stabilization in contaminated soils using various waste materials and to suggest a direction for future field research.
Pay for performance schemes are increasingly being implemented in low income countries to improve... more Pay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets. 40 in-depth interviews and four focus group discussions were undertaken with health workers, and regional, district and facility managers. Data was collected on work environment characteristics and staff attitudes towards work in the first phase of the implementation of the pilot. A survey of 75 facilities and 101 health workers were carried out to examine facility resourcing, and health worker employment conditions and job satisfaction. Five contextual factors which affect the implementation of P4P were identified by health workers: salary and employment benefits; resource availability, including staff, medicines and functioning equipment;...
Interest in abortion research is reemerging, partly as a result of political changes and partly d... more Interest in abortion research is reemerging, partly as a result of political changes and partly due to evidence of the contribution of induced abortion to maternal mortality in developing countries. Information is lacking on all aspects of induced abortion, particularly methodological issues. This article reviews the methodological dilemmas encountered in previous studies, which provide useful lessons for future research on induced abortion and its complications, including related deaths. Adverse health outcomes of induced abortion are emphasized, because these are largely avoidable with access to safe abortion services. The main sources of information are examined, and their relevance for assessing rates of induced abortion, complications, and mortality is addressed. Two of the major topics are the problems of identifying cases of induced abortion, abortion complications, and related deaths, and the difficulties of selecting a valid and representative sample of women having the outcome of interest, with an appropriate comparison group. The article concludes with a discussion of approaches for improving the accuracy, completeness, and representativeness of information on induced abortion. Although the prospects for high-quality information seem daunting, it is essential that methodological advances accompany program efforts to alleviate this important public health problem.
This is an exhaustive survey by this committed project for women's dignity. The women are concern... more This is an exhaustive survey by this committed project for women's dignity. The women are concerned primarily for the problem of fistula, but the survey covers all aspects of health services for poor women. The report concludes with 7 points for reflection and action. Here are the contents, the executive summary, the conclusions, and the bibliography. For the whole document go to http://www.womensdignity.org/Peoples_experience.pdf JK Poor people s experiences of health services in Tanzania: A literature review Contents.
International Journal of Gynecology & Obstetrics, 1993
AbStIWt A. Introduction Maternal tetanus, defined as tetanus occurring during pregnancy or within... more AbStIWt A. Introduction Maternal tetanus, defined as tetanus occurring during pregnancy or within 6 weeks after any type of pregnancy termination, is one of the most easily preventable causes of maternal mortality. It includes postpartum or puerperal tetanus resulting from septic procedures during delivery, postabortal tetanus resulting from septic abortion and tetanus incidental to pregnancy, resulting from any type of wound during pregnancy. This review of published and unpublished hospital and community studies concludes that between 15 000 and 30 000 cases of maternal tetanus occur each year. Complete coverage of reproductive-aged women by tetanus toxoid is the most cost-effective way to eliminate this often neglected cause of maternal death.
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Papers by Masuma Mamdani