71 research outputs found
Challenges to the Implementation of International Health Regulations (2005) on Preventing Infectious Diseases: Experience from Julius Nyerere International Airport, Tanzania.
Get PDFThe International Health Regulations (IHR) (2005) is a legal instrument binding all World Health Organization (WHO) member States. It aims to prevent and control public health emergencies of international concern. Country points of entry (POEs) have been identified as potential areas for effective interventions to prevent the transmission of infectious diseases across borders. The agreement postulates that member states will strengthen core capacities detailed in the IHR (2005), including those specified for the POE. This study intended to assess the challenges faced in implementing the IHR (2005) requirements at Julius Nyerere International Airport (JNIA), Dar es Salaam. A cross-sectional, descriptive study, employing qualitative methods, was conducted at the Ministry of Health and Social Welfare (MoHSW), WHO, and JNIA. In-depth interviews, focus group discussions (FGDs) and documentary reviews were used to obtain relevant information. Respondents were purposively enrolled into the study. Thematic analysis was used to generate study findings. Several challenges that hamper implementation of the IHR (2005) were identified: (1) none of the 42 Tanzanian POEs have been specifically designated to implement IHR (2005). (2) Implementation of the IHR (2005) at the POE was complicated as it falls under various uncoordinated government departments. Although there were clear communication channels at JNIA that enhanced reliable risk communication, the airport lacked isolated rooms specific for emergence preparedness and response to public health events. JNIA is yet to develop adequate core capacities required for implementation of the IHR (2005). There is a need for policy managers to designate JNIA to implement IHR (2005) and ensure that public health policies, legislations, guidelines, and practice at POE are harmonized to improve international travel and trade. Policy makers and implementers should also ensure that implementation of the IHR (2005) follow the policy implementation framework, particularly the contextual interaction theory which calls for the availability of adequate resources (inputs) and well-organized process for the successful implementation of the policy
Challenges to the Implementation of Health Sector Decentralization in Tanzania: Experiences from Kongwa District Council.
Get PDFDuring the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers' accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process
The role of social capital in HIV prevention: experiences from the Kagera region of Tanzania
No full textBackground The role of social capital for promoting health has been extensively studied in recent years but there are few attempts to investigate the possible influence of social capital on HIV prevention,particularly in developing countries. The overall aims of this thesis are to investigate the links between social capital and HIV infection and to contribute to the theoretical framework of the role of social capital for HIV prevention. Methods Key informant interviews with leaders of organizations, networks, social groups and communities and focus group discussions with members and non-members of the social groups and networks were conducted to map out and characterize various forms of social capital that may influenceHIV prevention. A quantitative community survey was carried out in three case communities toestimate the influence of social capital on HIV risk behaviors. A cross-sectional survey was conducted to estimate the HIV prevalence in the urban district representing a high HIV prevalence zone to determine the association between social capital and HIV infection. Main findings In early 1990’s many of the social groups in Kagera region were formed because of poverty and many AIDS related deaths. This formation of groups enhanced people’s social and economic support to group members during bereavement and celebrations as well as provided loans that empowered members economically. The social groups also put in place strict rules of conduct, which helped to create new norms, values and trust, which influenced sexual health andthereby enhanced HIV prevention. Formal organizations worked together with social groups and facilitated networking and provided avenues for exchange of information including healtheducation on HIV/AIDS. Individuals who had access to high levels of structural and cognitive social capital were more likely to use condoms with their casual sex partners compared to individuals with access to low levels. Women with access to high levels of structural social capital were more likely to use condoms with casual sex partners compared to those with low levels. Individuals with access to low levels of structural social capital were less likely to be tested for HIV compared to those with access to high levels. However, there was no association between access to cognitive social capital and being tested for HIV. Individuals who had access to low levels of both structural and cognitive social capital were more likely to be HIV positive compared to individuals who had access to high levels with a similar pattern among men and women. Conclusion This thesis indicates that social capital in its structural and cognitive forms is protective to HIV infection and has played an important role in the observed decline in HIV trends in the Kagera region. Structural and cognitive social capital has enabled community members to decrease number of sexual partners, delay sexual debut for the young generation, reduce opportunities for casual sex and empower community members to demand or use condoms. It is recommended that policy makers and programme managers consider involving grassroots’ social groups and networks in the design and delivery of interventions strategies to reduce HIV transmission
Health System and Patient Factors Facilitating the Implementation of Isoniazid Preventive Therapy for People living with HIV attending Care and Treatment Centres in Songea Municipality, Tanzania
No full textIsoniazid Preventive Therapy (IPT) is an essential public health intervention for people living with HIV (PLHIV), especially in low-income countries with high tuberculosis (TB) and HIV burden. Despite available evidence that IPT is efficacious, its implementation is still low in many countries. Therefore, this study aimed to determine the coverage of IPT implementation and explore factors facilitating the implementation of IPT in Songea municipality, Tanzania. The study employed a cross-sectional descriptive study design using both quantitative and qualitative approaches of data collection. A review of 2148 records of PLHIV eligible for IPT was done to determinecoverage of IPT implementation. 21 in-depth interviews and 5 observations were conducted to explore factors facilitating IPT implementation. Overall, IPT coverage of the municipality was estimated to be 45%. The study revealed that the availability of IPT training, regular supportive supervision, collaboration between TB and HIV programs, availability of IPT guidelines and patient registers were the main factors facilitating the implementation of IPT. The study recommends that local government authorities, managements of healthcare facilities, drug suppliers, and partners working in TB and HIV programs, service providers, community leaders and community health workers should continue working together and ensure that the identified facilitating factors are sustained to increase the coverage of IPT to reach at least the minimum 50% as recommended by the WHO
Gender context of sexual violence and HIV sexual risk behaviors among married women in Iringa Region, Tanzania
No full textBackground: There is a dearth of empirical research illuminating possible connections between gender imbalances and sexual violence among married women in Tanzania. There is a need to generate in-depth information on the connectivity between gender imbalances (asymmetrical resource ownership, sexual decision making, roles, and norms) and sexual violence plus associated HIV risky sexual behavior among married women. Design: This paper is based on a qualitative case study that involved use of focus group discussions (FGDs). A thematic analysis approach was used in analyzing the study findings. Results: The study findings are presented under the three structures of gender and power theory. On sexual division of labor, our study found that economic powerlessness exposes women to sexual violence. On sexual division of power, our study found that perception of the man as a more powerful partner in marriage is enhanced by the biased marriage arrangement and alcohol consumption. On cathexis, this study has revealed that because of societal norms and expectations regarding women's sexual behavior characterized by their sexual and emotional attachments to men, women find it hard to leave sexually abusive marriages. That is, because of societal expectations of obedience and compelled tolerance many married women do suffer in silence. They find themselves trapped in marriages that increase their risk of acquiring HIV. Conclusions: This study suggests that married women experience a sexual risk of acquiring HIV that results from non-consensual sex. That non-consensual sex is a function of gender imbalances – ranging from women's economic dependence on their husbands or partners to socioculturally rooted norms and expectations regarding women's sexual behavior. The HIV risk is especially heightened because masculine sexual norms encourage men [husbands/partners] to engage in unprotected intra- and extramarital sex. It is recommended that the Tanzania Commission for AIDS (TACAIDS) should address the gender dimensions of sexual violence in marriage
Factors influencing the uptake of cervical cancer screening services in Tanzania: A health system perspective from national and district levels
No full textFactors that hinder community participation in developing and implementing comprehensive council health plans in Manyoni District, Tanzania
No full textBackground: Decentralization of public health planning is proposed to facilitate public participation in health issues. Health Sector Reform in Tanzania places emphasis on the participation of lower level health facilities and community in health planning process. Despite availability of policies, guidelines, and community representative organs, actual implementation of decentralization strategies is poorly achieved. This study intended to find out factors that hinder community participation in developing and implementing Comprehensive Council Health Plan (CCHP). Materials and methods: A qualitative approach was conducted in this study with key informants from Health Facility Governing Committees (HFGC), Council Health Service Board (CHSB), and Council Health Management Team (CHMT). Data were collected using in-depth interviews. Data generated were analyzed for themes and patterns. Results: Factors that hindered community participation included lack of awareness on the CCHP among HFGC members, poor communication and information sharing between CHMT and HFGC, unstipulated roles and responsibilities of HFGC, lack of management capacity among HFGC members, and lack of financial resources for implementing HFGC activities. Conclusions: The identified challenges call for policy makers to revisit the decentralization by devolution policy by ensuring that local governance structures have adequate resources as well as autonomy to participate in planning and managing CCHP in general and health facility plans in particular
Social capital and self-rated health: experiences from Makete district, Tanzania
Get PDFBackground: It is almost two decades since various research works started documenting the debate surrounding the role of social capital on individual health outcomes in different contexts. However, in Tanzania there is a dearth of empirical evidence showing how social capital influences health outcomes. The objective of this study was to investigate the links between individual social capital and self-rated health by selected socio-demographic factors.Methods: We conducted a population-based cross-sectional study in Makete district in the south-western Tanzania. A semi-structured questionnaire was used to collect data using face to face interviews with the study participants. We collected information on individual structural social capita, which include memberships in organizations, giving social support, receiving social support and participation in voluntary activities. We also collected information on individual cognitive social capital including visiting neighbour, trusting neighbour, interaction with neighbour and ability to influence in decisions.Results: A total of 862 individuals from four villages participated in the study with the mean age of 31.3 years. Factor analysis (using principal components analysis) with varimax determined four domains of structural social capital: participation in collective activities, giving social support, membership in formal and informal organizations and receiving social support (factor loadings: 0.65 to 0.55). Four domains of cognitive social capital were also identified: visiting a sick neighbour, trusting a neighbour, and interacting with neighbour and ability to influence decisions (Factors loadings: 0.78 to 0.52). The multivariable logistic regression analysis shows that individuals with access to medium and high levels of structural social capital were almost 2 and 3 times more likely to report good health than individuals with low social capital [OR 2.3 (CI: 1.6-3.4)] and [OR 3.4 (CI: 2.3-5.1)], respectively.Conclusion: Our study findings support the argument that high level of structural social capital has positive health outcomes in rural Tanzania’ setting. Therefore, village leaders in particular and community members in general should promote social capital in their communities as one of the health interventions towards improving individual health.
Factors that Hinder Community Participation in Developing and Implementing Comprehensive Council Health Plans in Manyoni District, Tanzania.
Get PDFDecentralization of public health planning is proposed to facilitate public participation in health issues. Health Sector Reform in Tanzania places emphasis on the participation of lower level health facilities and community in health planning process. Despite availability of policies, guidelines, and community representative organs, actual implementation of decentralization strategies is poorly achieved. This study intended to find out factors that hinder community participation in developing and implementing Comprehensive Council Health Plan (CCHP). A qualitative approach was conducted in this study with key informants from Health Facility Governing Committees (HFGC), Council Health Service Board (CHSB), and Council Health Management Team (CHMT). Data were collected using in-depth interviews. Data generated were analyzed for themes and patterns. Factors that hindered community participation included lack of awareness on the CCHP among HFGC members, poor communication and information sharing between CHMT and HFGC, unstipulated roles and responsibilities of HFGC, lack of management capacity among HFGC members, and lack of financial resources for implementing HFGC activities. The identified challenges call for policy makers to revisit the decentralization by devolution policy by ensuring that local governance structures have adequate resources as well as autonomy to participate in planning and managing CCHP in general and health facility plans in particular
Facilitators and barriers to health care access among the elderly in Tanzania: A health system perspective from managers and service providers.
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