Papers by Respicius Shumbusho Damian
Public health open access, 2024
Community and Public Engagement (CPE) is increasingly acknowledged as an appropriate approach in ... more Community and Public Engagement (CPE) is increasingly acknowledged as an appropriate approach in healthcare and other policy related research. However, it is also becoming clear that community engagement necessarily involves and is significantly affected by politics. This paper illuminates the manifestations of politics in community engagement research drawing examples from a community-level study that was carried out in Kasulu, a rural district in Tanzania. Specifically, the paper starts by providing some conceptual highlights on community engagement and politics, then it proceeds to show the different forms and shapes that politics can take in community-level research. Further, it argues that community engagement is by its nature a defacto victim of politics. Finally, it suggests workable strategies and tactics that could be considered by community engagement researchers to remedy scientific research from being adulterated by politics. Four strategies that were employed in our project namely creating cognitively aware communities, preparing and orienting stakeholders to engagement guidelines, the use of Community Advisory Committees, and ensuring diversity in all engagement platforms are described and exemplified. If effectively used, these measures can potentially improve the uptake and sustainability of the solutions that community-level healthcare engagement research partnerships tend to generate.
The Consortium for Advanced Research Training in Africa (CARTA) and the University of Dar es Sala... more The Consortium for Advanced Research Training in Africa (CARTA) and the University of Dar es Salaam supported this research. CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK)(Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399),Google.Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10-95915-000-INP. The funding organizations did not contribute to the design of the study or analysis and interpretation of the data.
This paper was a result of a preliminary research preceding a PhD study, which was partially supp... more This paper was a result of a preliminary research preceding a PhD study, which was partially supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK) (Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399), Google.Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10-95915-000-INP. I also thank the University of Dar es Salaam, Tanzania and Shumbusho and Associates Tanzania Limited for availing supplementary resources for completion of preliminary study paper.
Health Policy and Planning, 2021
Although increasing public spending on health worker (HW) recruitments could reduce workforce sho... more Although increasing public spending on health worker (HW) recruitments could reduce workforce shortages in sub-Saharan Africa, effective strategies for achieving this are still unclear. We aimed to understand the process of transitioning HWs from President’s Emergency Plan for AIDS Relief (PEPFAR) to Government of Uganda (GoU) payrolls and to explore the facilitators and barriers encountered in increasing domestic financial responsibility for absorbing this expanded workforce. We conducted a multiple case study of 10 (out of 87) districts in Uganda which received PEPFAR support between 2013 and 2015 to expand their health workforce. We purposively selected eight districts with the highest absorption rates (‘high absorbers’) and two with the lowest absorption rates (‘low absorbers’). A total of 66 interviews were conducted with high-level officials in three Ministries of Finance, Health and Public Service (n = 14), representatives of PEPFAR-implementing organizations (n = 16), distri...
International Journal of Public Health, 2020
Objectives Representation of the key groups in community-level healthcare decisions is a prerequi... more Objectives Representation of the key groups in community-level healthcare decisions is a prerequisite for accountable and responsive primary healthcare systems. However, meaningful representation requires both the presence of individuals who represent the key community groups and their capacity to influence the key healthcare plans and decisions. Our study explored how the underrepresentation of the youth in health facility committees, the decentralized community-and facilitylevel healthcare decision-making forums affects youth access to sexual and reproductive health services. Methods A multisite case study involving focus group discussions, interviews, and meeting observation was conducted in eight primary healthcare facilities in Kasulu, a rural district in Tanzania. Inductive thematic analysis was used to identify the key emerging themes. Results Five major themes were identified in connection with youth underrepresentation and limited access to sexual reproductive health as a 'taboo' phenomenon in the communities. These were: numbers do not matter, passive representation, sociopolitical gerontocracy, economic vulnerability, and mistrust and suspicion. Conclusions Gradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions. Keywords Youth representation Á Sexual and reproductive health Á Health facility committees Á Healthcare access Á Tanzania This article is part of the special issue ''Sexual and reproductive health of young people-Focus Africa''. The Rudolf Geigy Foundation (Basel, Switzerland) funded the open access publication of this article.
Global health research and policy, 2018
Despite increasing recognition that health-systems constraints are the fundamental barrier to att... more Despite increasing recognition that health-systems constraints are the fundamental barrier to attaining anti-retroviral therapy (ART) scale-up targets in Sub-Saharan Africa, current discourses are dominated by a focus on sustainability. Utilizing the health system dynamics framework, this study aimed to explore the interactions in health system components and their influence on the sustainability of ART scale-up implementation in Uganda. This study entailed qualitative organizational case-studies within a two-phased mixed-methods sequential explanatory research design. In Phase One, a survey of 195 health facilities across Uganda which commenced ART services between 2004 and 2009 was conducted. In Phase Two, six health facilities were purposively selected for in-depth examination involving i) In-depth interviews ii) and semi-structured interviews (). Qualitative data was analyzed by coding and thematic analysis. Descriptive statistics were managed in STATA (v 13). Five dynamic inter...
Although expanding fiscal space for health worker recruitments could reduce workforce shortages i... more Although expanding fiscal space for health worker recruitments could reduce workforce shortages in Sub-Saharan Africa, effective strategies for achieving this are still unclear. We aimed to understand the process of transitioning health workers (HWs) from PEPFAR to Government of Uganda (GoU) payrolls and to explore the facilitators and barriers encountered in increasing domestic financial responsibility for absorbing this transitioned workforce. We conducted a multiple case-study of 10 (out of 87) districts in Uganda which received PEPFAR support between 2013 and 2015 to expand their health workforce. We purposively selected eight districts with the highest absorption rates (‘High absorbers’) and two with the lowest absorption rates (‘Low absorbers’). A total of 66 interviews were conducted with high-level officials in three Ministries of Finance, Health and Public Service (n = 14), representatives of PEPFAR implementing organizations (n = 16), District Health Teams (n = 15) and fac...
This paper analyzes the capability and influence of rural community actors in community-based hea... more This paper analyzes the capability and influence of rural community actors in community-based healthcare governance partnerships, namely the Health Facility Governance Committees (HFGCs) using the Lay Participant perspective. Practical evidences are drawn from a mixed methods study conducted in Karagwe and Morogoro districts between May 2013 and March 2015. The analysis shows that all community actors, especially individual community members, community representatives, elected community leaders, informal community groups, and Civil Society Organizations (CSOs) as well as Non-Governmental Organizations (NGOs) have pertinent weaknesses that make them unable to contribute effectively towards enforcing accountability of public officials and health services providers. The main reason is that, the design and social context of rural communities make partnerships for empowerment partnerships for disempowerment. In conclusion, community-based healthcare governance partnerships cannot work best in the current context of Tanzanian rural communities. Therefore, there is a need for rational capacity building interventions aimed at empowering all the defined community actors and transformational redesign of the community healthcare governance systems.
This research was supported by the University of Dar es Salaam and the Consortium for Advanced Re... more This research was supported by the University of Dar es Salaam and the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK)(Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100–0399),Google.Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10– 95915-000-INP. The funders did not in any way contribute to the design of the study and collection, analysis, and interpretation of data.
Transitioning health workers from PEPFAR contracts to the Uganda government payroll, 2021
Although increasing public spending on health worker (HW) recruitments could reduce workforce sho... more Although increasing public spending on health worker (HW) recruitments could reduce workforce shortages in sub-Saharan Africa, effective strategies for achieving this are still unclear. We aimed to understand the process of transitioning HWs from President's Emergency Plan for AIDS Relief (PEPFAR) to Government of Uganda (GoU) payrolls and to explore the facilitators and barriers encountered in increasing domestic financial responsibility for absorbing this expanded workforce. We conducted a multiple case study of 10 (out of 87) districts in Uganda which received PEPFAR support between 2013 and 2015 to expand their health workforce. We purposively selected eight districts with the highest absorption rates ('high absorbers') and two with the lowest absorption rates ('low absorbers'). A total of 66 interviews were conducted with high-level officials in three Ministries of Finance, Health and Public Service (n = 14), representatives of PEPFAR-implementing organizations (n = 16), district health teams (n = 15) and facility managers (n = 22). Twelve focus groups were conducted with 87 HWs absorbed on GoU payrolls. We utilized the Consolidated Framework for Implementation Research to guide thematic analysis. At the sub-national level, facilitators of transition in 'high absorber' districts were identified as the presence of transition 'champions', prioritizing HWs in district wage bill commitments, host facilities providing 'bridge financing' to transition workforce during salary delays and receiving donor technical support in district wage bill analysis-attributes that were absent in 'low absorber' districts. At the national level, multi-sectoral engagements (incorporating the influential Ministry of Finance), developing a joint transition road map, aligning with GoU salary scales and recruitment processes emerged as facilitators of the transition process. Our case studies offer implementation research lessons on effective donor transition and insights into pragmatic strategies for increasing public spending on expanding the health workforce in a low-income setting.
International Journal of Public Health, 2020
Objectives: Representation of the key groups in community-level healthcare decisions is a prerequ... more Objectives: Representation of the key groups in community-level healthcare decisions is a prerequisite for accountable and responsive primary healthcare systems. However, meaningful representation requires both the presence of individuals who represent the key community groups and their capacity to influence the key healthcare plans and decisions. Our study explored how the under-representation of the youth in health facility committees, the decentralized community- and facility-level healthcare decision-making forums affects youth access to sexual and reproductive health services.
Methods: A multi-site case study involving focus group discussions, interviews, and meeting observation was conducted in eight primary healthcare facilities in Kasulu, a rural district in Tanzania. Inductive thematic analysis was used to identify the key emerging themes.
Results: Five major themes were identified in connection with youth under-representation and limited access to sexual reproductive health as a ‘taboo’ phenomenon in the communities. These were: numbers do not matter, passive representation, sociopolitical gerontocracy, economic vulnerability, and mistrust and suspicion.
Conclusions Gradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions.
International Journal of Development and Sustainability, 2018
Stock-outs of essential medicines and medical items remains a persistent problem in Tanzania, des... more Stock-outs of essential medicines and medical items remains a persistent problem in Tanzania, despite the several policy initiatives and interventions since the 1990s. We conducted a qualitative case study, which involved 24 in-depth interviews and eight focus group discussions with the Community Health Fund stakeholders who were facility in-charges, grassroots leaders, and members of Health Facility Governance Committees from eight primary health facilities in Kasulu District Council. The analysis involved transcribing and coding textual data to identify the key themes that emerged. The study identified four main themes that explained how the politics contribute to persistent stock outs, especially: 1) stock-outs as capital in electoral politics; 2) misinformation and rent-seeking; 3) dyads among street-level bureaucrats; and 4) competition and struggle for power and control over resources. We also identified four themes reflecting the dominant perceptions associated with stock-outs in the study communities namely: 1) feeling marginalized; 2) mistrust and suspicion of authority; 3) frustration of health workers; and 4) informal drug sellers as ‘the best'. These perceptions influence the way communities tend to define their role in health care financing and governance as well as the relationship between communities and health workers. While economic, administrative, and technical forces might influence stock outs, the politics within the management and governance of the Community Health Fund, which included rent-seeking, misinformation, and competition, significantly affected the legitimacy of the Community Health Fund. The resulting low enrollment and unwillingness to contribute makes medicines’ financing from community sources unsustainable. Therefore, empowering communities to mobilize locally available resources and exercise autonomous control over financial resources and medicine is imperative for addressing persistent stock outs.
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Papers by Respicius Shumbusho Damian
Methods: A multi-site case study involving focus group discussions, interviews, and meeting observation was conducted in eight primary healthcare facilities in Kasulu, a rural district in Tanzania. Inductive thematic analysis was used to identify the key emerging themes.
Results: Five major themes were identified in connection with youth under-representation and limited access to sexual reproductive health as a ‘taboo’ phenomenon in the communities. These were: numbers do not matter, passive representation, sociopolitical gerontocracy, economic vulnerability, and mistrust and suspicion.
Conclusions Gradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions.
Methods: A multi-site case study involving focus group discussions, interviews, and meeting observation was conducted in eight primary healthcare facilities in Kasulu, a rural district in Tanzania. Inductive thematic analysis was used to identify the key emerging themes.
Results: Five major themes were identified in connection with youth under-representation and limited access to sexual reproductive health as a ‘taboo’ phenomenon in the communities. These were: numbers do not matter, passive representation, sociopolitical gerontocracy, economic vulnerability, and mistrust and suspicion.
Conclusions Gradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions.