37 research outputs found
Understanding Stakeholders’ Roles in Health Sector Reform Process in Tanzania: The Case of Decentralizing the Immunization Program.
Get PDFThe current need and enthusiasm for health reforms open an important arena for deeper analysis of the policy process with a view to understanding the political determinants of reforms and strengthening implementation. The studies described in this thesis analyse positions of different actors in the reform process, their actions in support or opposition of the process, and their impact on the health sector reform process. Globally and especially in developing countries health sector reforms have been implemented over long periods. Although there have been improvements in health, the remaining burden of disease in many countries is still very high. Reasons for the high burden of disease have been classified into lack of resources and poor organizational and managerial capacity. Good stewardship was needed to facilitate improvement in the performance of health systems. Stakeholders’ alignment and support was one of the most important components of good stewardship. However, stakeholder analysis had not been a common undertaking in developing countries despite the reforms that were being implemented in most of them. It was the aim of this study to answer the question: What has been the role and importance of stakeholders in supporting or opposing the health sector reform process? The study was conducted in Tanzania as one of the poorest countries in Africa, using the decentralization of the Expanded Programme on Immunization (EPI) as a case reference. The study units were the Ministry of Health Headquarters, Medical Stores Department, Expanded Programme on Immunization, national archives, regions and districts. At district level the study units were District Council, Council Health Management Team, EPI managers at regional and district levels, ward and village authorities, health facility, facility providers and households. Qualitative and quantitative methods were used to collect data from January 2000 to June 2002. Relevant data collection instruments were prepared and pre-tested. The qualitative data collection methods included document review, in-depth interviews, key informants interviews and observations. Quantitative methods involved retrieval of secondary data, health facility survey and household surveys. Regular discussions with key informants and data collectors were held to verify the findings. Qualitative data was analysed manually. Quantitative data was captured and analysed using Epi Info version 6.1 and STATA version 6.0. The study involved answering five main questions. The first question was: Do reforms learn from history? Analysis of the waves of health reforms prior to the current reforms from 1926 was done to answer the question. The main stakeholders in the reforms were the political party in power, the government and donors who supported the reforms each time. Each wave of health sector reforms provided information on health provision, financing and resource generation. Due to the political contexts, information on failures of health financing did not provide lessons for succeeding reforms of the health sector. Stakeholders’ political interests opposed lessons that did not match the political ideology at the time i.e. free public services versus privatization and paying for social services. Lessons from previous health reforms were selective, and did not consider health-financing needs among others. The ongoing health reforms needed to use information from all functional aspects of the health system to provide lessons for improving the health system. The second question was: Who were the stakeholders in the current health reforms and what were their interests and reactions? The main stakeholders were donors, and the government. The two had a very high support for the reforms evidenced by their participation in problem identification, justification, reform design, planning and implementation. The health sector reforms thus had high political support at central level. In the implementation process, issues that triggered stakeholders’ reaction included sectoral versus local government decentralization. Another issue was the donor modality in financing the health sector and need for adopting new financial management systems. Among the donors there was hesitancy to join the common financing modalities that included a Sector Wide Approach (SWAp) and Basket Funding. As a result, there was delay in the process in order to reach better consensus. The third question was: What was the impact of stakeholders in the process of reforming a vertical programme like EPI? Health Sector Reforms in EPI included integration of generic functions, for example, vaccine procurement to medical stores department. Qualitative and quantitative data was collected and analysed from the Ministry of Health, EPI management unit. This again revealed that EPI reforms were well supported by the government and donors centrally. EPI managers at both district and regional levels opposed some of the EPI reforms. They argued that coverage was falling due to the reforms. However, there was no concrete evidence relating reforms in the EPI programme and falling coverage. The primary aim of certain actors was to make sure that they continued receiving extra income from EPI functions. One of the effects of stakeholders’ reaction was reversal of reforms (recentralization) and return to the status quo. The fourth question was: What was the immediate reaction of stakeholders to decentralization at district level and how might it have affected performance of EPI functions and the challenges? The immediate reaction of stakeholders was reduced cooperation between the Council Health Management Team (CHMT) and the District Council who were politically supreme in the district. Within the Council Health Management Team there was inadequate communication, which led to poor teamwork. The result of this was reduced supervisory visits to peripheral health facilities. The EPI coverage in the study district was 52.8 per cent, which was well below the previous national average (80 per cent). A logistic regression model for EPI service quality variables on children between 12 months and 23 months who had completed vaccination was applied. Certain EPI quality of service variables predicted significant changes in the odds ratio for completing vaccination. It was then suggested that strategies were needed to improve management skills among the CHMT and District Council members. Also there was a need of hastening the process of increasing remuneration and motivation of peripheral health workers. The fifth and final question was: What was the interest of the stakeholders and prospects of increasing EPI coverage at district level? Decentralization and integration of EPI functions were among the reforms at district level. The analysis revealed that active stakeholders at district level were the Ministry of Health, CHMT, EPI managers at district and regional levels and facility providers. The Ministry of Health opposed integration of EPI at district level by issuing the directive that DCCOs and MCHCOs (EPI manager at district level) should resume their tasks. However, the CHMT had no option but to comply. This action reversed some of the health reforms at district level. Analysis of the importance the community attached to EPI, using willingness to pay for EPI cold chain kerosene, was done. The support was low (48.7 per cent). EPI service quality variables were significantly negatively associated with odds ratio for willingness to pay for EPI input. Simulation with Policy Maker computer software predicted that an increased number of stakeholders through community participation would significantly improve the current low level of EPI coverage. It was then proposed to do a similar analysis in other vertical programmes and implement on a trial basis the results of the simulation. In conclusion, stakeholders were found to be active and influential in the health sectors of developing countries like Tanzania but poorly considered in implementation of reforms. Stakeholders are important since some strongly support while others oppose the reforms. The reaction of stakeholders is evident through deployment or non-deployment of information depending on interest and context. This would result in poor management leading to inefficiency in resource use, which would then be followed by poor quality of services, poor support by communities and consequently poor utilization of health services. It is suggested that stakeholder analysis be conducted in other vertical programmes in the process of integration. Promotion of stakeholder analysis and also Policy Maker as a tool to manage stakeholders will facilitate the management of reforms in the health sector
Water - Energy - Food Nexus Narratives and Resource Securities: A Global South Perspective
No full textWater-Energy-Food Nexus Narratives and Resource Securities: A Global South Perspective provides a knowledge synthesis on the water-energy-food (WEF) nexus, focusing primarily on the global south. By presenting concepts, analytical tools, and case studies, the book serves as a practical resource for researchers, policymakers, and practitioners in sustainability and functional roles across all three sectors. It addresses key issues related to data availability, tools, indices, metrics, and application across multiple scales, beginning with a summary of existing knowledge. Finally, it examines the WEF nexus, presents global insights, and discusses future considerations and implications. This book presents an overview of existing knowledge on the WEF nexus and examines how such research aligns with emerging global WEF nexus perspectives, making it ideal for professionals, government entities, private industry, and the general public.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Water Resource
Mean difference in soluble transferring receptor and serum transferrin among pregnant women infected with malaria compared to pregnant women without malaria.
No full text<p>Footnote: CI: confidence interval. SD: standard deviation. *Van Santen 2011 and Massawe 2002: study population primigravidae. Abrams 2005: study population HIV(-) women. The weight for each study is indicated as a grey block around the risk estimate. Removal of the study of Eteng 2010, an outlier for Serum Transferrin, gives the following result: Pooled mean difference Serum Transferrin (g/L): −0.11, 95% CI −0.30 to 0.09, I<sup>2</sup> 14.8%.</p
Geometric mean difference in ferritin among pregnant women infected with malaria compared to pregnant women without malaria.
No full text<p>Footnote: CI: confidence interval. SD: standard deviation. *Van Santen 2011 and Massawe 2002: study population primigravidae. Abrams 2005 and Ouedraogo 2012: study population HIV(-) women. The weight for each study is indicated as a grey block around the risk estimate. For Dreyfuss 2000, the malaria parasitemia was limited to <i>P. Vivax</i> in Asia. All other studies were conducted in Africa where <i>P. falciparum</i> is the predominant species.</p
Spatially continuous dataset at local scale of Taita Hills in Kenya and Mount Kilimanjaro in Tanzania
No full textAbstractClimate change is a global concern, requiring local scale spatially continuous dataset and modeling of meteorological variables. This dataset article provided the interpolated temperature, rainfall and relative humidity dataset at local scale along Taita Hills and Mount Kilimanjaro altitudinal gradients in Kenya and Tanzania, respectively. The temperature and relative humidity were recorded hourly using automatic onset THHOBO data loggers and rainfall was recorded daily using GENERALR wireless rain gauges. Thin plate spline (TPS) was used to interpolate, with the degree of data smoothing determined by minimizing the generalized cross validation. The dataset provide information on the status of the current climatic conditions along the two mountainous altitudinal gradients in Kenya and Tanzania. The dataset will, thus, enhance future research
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Predictors of Stunting, Wasting and Underweight among Tanzanian Children Born to HIV-Infected Women.
Get PDFChildren born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized. The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months. Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant's birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight. A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted. Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women
An Assessment of the Human Rights Attitudes toward Sexual Diversity in Kenya: A Case Study of Universities in Nairobi
No full textA Thesis Submitted To The School Of Humanities And Social Sciences In Partial Fulfillment Of The Requirement For The Award Of The Masters Of Arts Degree In International Relationsthe adoption of liberal constitutions that provide for extensive bills of rights in the world, there has been strong resistance among African countries to extend these rights to include minority groups, particularly the lesbian, gay, bisexual, transgender, queer and intersex (LGBTI) community. To date, same-sex sexual relations, particularly male to male sexual relations remain outlawed in more than two thirds of African countries, Kenya included. Although several African leaders have spoken out against homosexuality in very strong terms describing it as „un-African,‟ most laws criminalizing same-sex sexual acts were inherited from the colonial era and were enacted without the input of the people that currently enforce them. This study examines the opinions of ordinary African students in universities within Nairobi Kenya. It analyzes public opinion data from a questionnaire survey on the human rights attitudes toward homosexuality in Nairobi, Kenya, where the topic has been a subject of major debate in recent years especially with the current Kenyan president labeling same-sex sexuality as a “non-issue” in Kenya. This study also analyzes data from in-depth interviews with key informants in the LGBTI and human rights field in Kenya, and some within the Kenyan government. The author analyzes whether young educated adults in universities think homosexuality is ever acceptable, while trying to understand their moral, religious, and legal attitudes, and finding out whether they are willing to accept homosexuals living among them. The results indicate that the Kenyan students in universities still hold negative moral and religious attitudes toward homosexuality, with some minor variation by age, gender, and religion. However, they hold positive legal attitudes toward same-sex sexuality as a human rights issue which suggests that it may be possible to live in a country where laws do not have to specifically be made with respect to what is considered religiously correct by the population
Genomic and pedigree‐based predictive ability for quality traits in tea (Camellia sinensis (L.) O. Kuntze)
Get PDF© 2021, The Author(s). Genetic improvement of quality traits in tea (Camellia sinensis (L.) O. Kuntze) through conventional breeding methods has been limited, because tea quality is a difficult and expensive trait to measure. Genomic selection (GS) is suitable for predicting such complex traits, as it uses genome wide markers to estimate the genetic values of individuals. We compared the prediction accuracies of six genomic prediction models including Bayesian ridge regression (BRR), genomic best linear unbiased prediction (GBLUP), BayesA, BayesB, BayesC and reproducing kernel Hilbert spaces models incorporating the pedigree relationship namely; RKHS-pedigree, RKHS-markers and RKHS markers and pedigree (RKHS-MP) to determine the breeding values for 12 tea quality traits. One hundred and three tea genotypes were genotyped using genotyping-by-sequencing and phenotyped using nuclear magnetic resonance spectroscopy in replicated trials. We also compared the effect of trait heritability and training population size on prediction accuracies. The traits with the highest prediction accuracies were; theogallin (0.59), epicatechin gallate (ECG) (0.56) and theobromine (0.61), while the traits with the lowest prediction accuracies were theanine (0.32) and caffeine (0.39). The performance of all the GS models were almost the same, with BRR (0.53), BayesA (0.52), GBLUP (0.50) and RKHS-MP (0.50) performing slightly better than the others. Heritability estimates were moderate to high (0.35–0.92). Prediction accuracies increased with increasing training population size and trait heritability. We conclude that the moderate to high prediction accuracies observed suggests GS is a promising approach in tea improvement and could be implemented in breeding programmes
Petrochemistry and U–Pb (zircon) age of porphyry dykes at the McKenzie Gulch porphyry–skarn Cu–Ag–Au deposit, north-central New Brunswick, Canada: implications for emplacement age, tectonic setting, and mineralization potential
Get PDFNorth- to northeast-trending intermediate to felsic porphyry dykes in the McKenzie Gulch (MG) area intrude Upper Ordovician through Silurian calcareous sedimentary rocks of the Matapédia Group. These dykes are spatially associated with numerous copper–silver skarn occurrences. In this area, two distinct suites of dykes are recognized: plagioclase–hornblende porphyry (P–H) and quartz–plagioclase porphyry (Q–P). These suites yielded U–Pb (zircon) ages of 386.2 ± 3.1 Ma and 386.4 ± 3.3 Ma, respectively, indicating a coeval relationship and similar genesis despite slight geochemical and petrographical differences. Geochemical data indicate that the dykes are granodioritic to granitic to slightly tonalitic in composition with I-type and slab failure signatures. When compared with other granitoids in the region, the Murdochville suite in Gaspésie, Québec, is the only intrusion that exhibits slab failure magmatic signatures similar to the MG dykes. Magmas with slab failure signatures are compositionally similar to tonalite–trondhjemite–granodiorite (TTG) suites and adakites. They exhibit low Y and Yb concentrations and subsequent high Sr/Y and La/Yb ratios, which are interpreted to be the result of melting of subducting slab and mantle during the waning stages of collision and consequent slab failure. These processes were followed by assimilation and fractional crystallization of minerals such as hornblende and clinopyroxene (± titanite), which preferentially partition Y and heavy rare earth elements (HREE) in the absence of significant plagioclase. Magmas with similar geochemical characteristics worldwide have been proposed to be an important source for metals in most porphyry Cu and skarn deposits and consequently are a target during mineral exploration.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author
Gendered access to indirect benefits from natural gas extraction in Kilwa District, Tanzania
Get PDFInternational Journal of Social Sciences and Humanities, Vol. 4 No. 1, April 2020, pp: 1-12Natural gas extraction contributes substantially to the economy of many
countries around the world were natural gas resource is found. Despite its
potential benefits, it is not known to what extent the benefits are equally
enjoyed by both men and women in the respective host communities. The
existing studies focus more on benefit-sharing at the national level and lack
gender analysis. Using a cross-sectional design, a study was conducted to
establish gendered access to indirect benefits from natural gas extraction.
Quantitative data were collected from 373 households and qualitative data
through focus group discussions, key informant interviews, and participant
observation Findings revealed that about 53% of community members
categorized access to indirect benefits to be of high level. The indirect benefits
largely cut across investments and support in education, health, water, and
employment opportunities. The study concludes that, while investment by
Extractive Companies (ECs) has managed to improve health services the
shortage of technical staff has remained unsolved. Likewise, while various
benefits revealed to exist in education the chronic problem on girls drops out of
school remains to be a challenge. Therefore, the study recommends various
strategies to be adopted to address the remaining gender-related challenges
that limit fully enjoyment from ECs investment among men and women
