34 research outputs found
Measuring Inequalities in the Distribution of Health Workers: The case of Tanzania.
No full textThe overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities. We plotted Lorenz and concentration curves to illustrate graphically the distribution of the total health workforce and the cadre-specific (skill mix) distributions. Alternative indicators of health care needs were illustrated by concentration curves. Inequalities were measured by calculating Gini and concentration indices.\ud
There are significant inequalities in the distribution of health workers per capita. Overall, the population quintile with the fewest health workers per capita accounts for only 8% of all health workers, while the quintile with the most health workers accounts for 46%. Inequality is perceptible across both urban and rural districts. Skill mix inequalities are also large. Districts with a small share of the health workforce (relative to their population levels have an even smaller share of highly trained medical personnel. A small share of highly trained personnel is compensated by a larger share of clinical officers (a middle-level cadre) but not by a larger share of untrained health workers. Clinical officers are relatively equally distributed. Distributional inequalities tend to be more pronounced when under-five deaths are used as an indicator of health care needs. Conversely, if health care needs are measured by HIV prevalence, the distributional inequalities appear to decline. The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce
The impact of costs and perceived quality on utilisation of primary health care in Tanzania : rural-urban comparison
No full textHealth services utilisation, which is sometimes used as a proxy measure for equity is a complex subject to study. Identifying and explaining the important factors determining health care utilisation is a key to a better assessment of whether countries' health policies address the equity concerns of their populations in a comprehensive way. It is extensively documented that meeting the health needs of people especially those disadvantaged by such factors as geographical location, joblessness, low income, gender inequalities and lack of education among others, is an important strategy to preventing the increase in poverty and eventually reducing equity gaps. Realising this goal is not easy unless studies are done to establish policy and theoretical arguments related to why some sections of populations are more likely to use/or not to use available health care services than others. This cross-sectional study principally aims at assessing the impact of perceived quality and costs of health care on utilisation of PHC services in rural and urban areas of Tanzania. Using both quantitative and qualitative methods, it intends to explore whether there are differences between rural and urban users in terms of their perceptions of quality of health services and how these perceptions affect household decisions in utilising health services. It further examines the extent to which costs of health care are important determinant in health services utilisation and how rural and urban users are affected by this factor when it comes to deciding to use or not to use government health facilities. The study concludes that consumers of health care in rural Tanzania are highly responsive to health care costs than they are to quality concerns. As the two categories of rural and urban are affected differently by costs and their perceptions of quality when it comes to health care utilisation, it is possible that the observed utilisation trends can partly be attributed to these two factors. Furthermore, the study highlights that socio-economic variables such as gender, income, education, wealth and household size are important not only in determining user's decision making on the amount and appropriate time to seek care but also mitigates effectively on the extent to which costs and perception of quality of care affect rural and urban users of health care services. The study recommends that the government should strive to provide better "quality " information to its consumers. It further recommends that a critical evaluation of important quality aspects be done to see which mostly determine household decisions on utilisation of care among rural and urban users of care. The study has found that the kit system has had some problems, hence the study recommends that government devises mechanisms of ensuring that drugs are available at points of service. Acknowledging the existing geographical inequities, the need to incorporate the private sector in PHC provision and improve quality of health care, the study recommends for more resources to be devoted to research and venture on new opportunities provided by the ongoing reforms as a way of introduction, chapter one of the study report presents the country background information and how the health system is organised. The remainder of the report is organised as follows. In chapter two, the report presents the literature review whilst chapter three covers conceptual framework and methodology. This is followed by presentation of results and analysis in chapter four before putting forward a brief discussion of the findings in chapter five. In chapter six, conclusions and policy recommendations are presented
Experiences, Opportunities and Challenges of Implementing Task Shifting in Underserved Remote Settings: The Case of Kongwa District, Central Tanzania.
No full textTanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based
Theology, innovation and Society: Towards developing Dialogical Theology for African society
No full textTheology and society are inseparable due to the fact that they are both composed of that
which makes for both human and universal well-being. Indeed the two have through the ages
inspired each other in the pursuit of a better world. This paper aims to explore three
religions; African Indigenous Religion (AIR) Islam and Christianity as practised in
developing countries such as Kenya, with the intention of deducing whether or not believers
of these religions (can engage) engage in dialogue with each other for the purpose of
providing sustainable solutions for community well-being and wholeness. Theology of
dialogue is a methodology used by the author, as a means for innovation; towards creating
harmony and equilibrium in a plural and multi-religious Kenyan society and Africa in
general. Of significance for this timely theological concept in Africa are the dreams that need
achievement; the Millennium Development Goals and state visions such as the Kenya 2030
vision. In approaching the subject, the author shall endeavor to outline pre-colonial, colonial
and post-colonial religious histories in Africa. The author shall use the Midzi-Chenda
(written Mijiknda) community of Coastal Kenya as a case study population. This choice is
due to their diverse and long-lived inter-cultural and inter-religious experiences, particularly
with the Arab, Portuguese and British conquests along the East Coast of Africa. The triple
conquest experiences influenced the Midzi-Chenda community negatively and positively in all
spheres of their life-system; economic, political and religious, compelling them to embrace
foreign culture, religion and politics, all of which gradually shaped their theological
parameters. This latter experience and the contemporary post-colonial religious wave
significantly situate the theology of dialogue as a benchmark for innovation in African
society
Equity Implications of Health Sector User Fees\ud in Tanzania : Do we Retain the User Fee or do we Set the User F(r)ee?
No full text\ud
Early 2004, Research for Poverty Alleviation (REPOA) commissioned ETC Crystal to examine the equity implications of health sector user fees in Tanzania, with particular reference to proposed and actual charges at dispensary and health centre level. This year, Tanzania will review its Poverty Reduction Strategy. With the findings of the user fee study, REPOA aims at making a valuable contribution to the review process and provide country-specific insight into one of the most debated issues in health financing. The focus and design of the study was formulated in close cooperation with the Research and Analysis Working Group of REPOA. The strategies for data collection comprised: (1) a comprehensive literature analysis literature, (2) semi-structured interviews with resource persons from the government of Tanzania, multi- and bilateral donors, research institutes and NGOs in Dar Es Salaam, and (3) a case study in Kagera Region, including both document analysis and semi-structured interviews with resource persons from the MOH, NGOs, FBOs, health workers and health care consumers from vulnerable and poor population groups. The study team developed multiple tools for data collection and analysis including: (1) a data matrix for categorisation and identification of key issues, (2) guidelines for the interviews in Dar Es Salaam, (3) guidelines for data collection and interviews in Kagera Region, and (4) a tool for the analysis of poverty reduction strategy documents. A total number of 170 user fee-related documents were assessed, including those covering the experience from neighbouring countries. Seventy-nine resource persons participated in the study. Resources generated by user fees and their use at hospital, district council and PHC levels. The study team found that reliable, transparent user fee income data for district, hospital and PHC level were difficult to obtain. Based on what information is available, the team concludes that revenues raised from user fees at the hospital level have been lower than what has been projected. Furthermore, the data reflect huge variations between facilities and a decline in the revenues from cost sharing. The reasons of the reported decline are unclear. The data reflecting the contribution of user fees and CHF to the health budget at district council level show huge variations as well. The reported user fee income proportion for the district health budget was on average 10.5%. The study team could not establish how the income from cost sharing and the CHF was re-distributed by the council to PHC facilities or priority areas. A worrying finding was that some councils did not spend all health resources in the health sector. The study team observes an urgent need for: (1) more accurate and comprehensive record keeping at local council level, and (2) more costing and tracking studies to obtain a better insight into cost sharing and expenditures and to adequately inform policy making. Contribution of user fees and CHFs to the health resource envelope. The study team concludes that the national projections of the cost sharing schemes do not reflect an accurate picture, since the data are based on the inaccurate financial data received from the districts. It is likely that the actual and projected data on user fees, CHFs and HSF are underestimations of the real income collected at the different facility levels. This means that the MOH faces a loss of income that cannot be redistributed to the health sector. It also implies that people (both wealthy and poor) are likely pay more than what is officially reported. The actual potential and use of the non-reported user fees are not known. The total contribution of the cost sharing schemes (excluding NHIF) to the national health resource envelope for FY03/04 is 1.67 Billion Tshs. This equals a contribution of 0.6% to the overall budget for the health sector. In total, this is US 260 million), it can be concluded that the officially reported user fees contribute a small proportion only. The actual revenue generated does not meet the initial expectations. Contribution of revenues generated to improved services. The study team found limited positive evidence that user fees in Tanzania have in general achieved their original objectives of sustainability, drug availability, quality of care, equity and access for the poor. More specifically, the study team found that government-run PHC facilities appeared to face severe shortages of drugs and supplies. In addition, user fees were not always retained at PHC level, but deposited in the HSF account which mainly benefits the purchase of supplies for the district hospital. Positive results were seen for reinvestment of CHF funds. In total, 50% of the health workersand patients reported improvements in drugs availability, diagnostic facilities and maintenance. However, equity criteria for the distribution of available resources from the user fee income to PHC level are not systematically followed. Impact of user fees on access to health services. The study team concludes that presently, the user fees in Tanzania are regressive and contribute to substantial exclusion, self exclusion and increased marginalisation. The team has collected evidence which shows that user fees have disproportionally affected access to health care for poor and vulnerable population groups, more specifically: (1) pregnant women from poor households, (2) under-five children from poor households, (3) orphans and especially double orphans, (4) widows, (5) people older than 60 years, (6) people with disabilities, and (7) AIDS patients. Further extension of fees to dispensary and health centre level. Also at the PHC level, the study team found that fees have negatively impacted the use of health care by the rural poor population, particularly women and children. Given the importance of the public PHC facilities for poor people (government health centres are the main choice for out-patient care for the poor), the study team expects that the further extension of user fees to PHC level without effective exemption and waiver mechanisms will contribute to further exclusion and selfexclusion. Effectiveness of exemption and waiver mechanisms. The study team identifies the ineffectiveness of the present exemption and waiver mechanisms as the core problem in the user fee debate in Tanzania. A functional exemption and waiver system is actually non-existent putting vulnerable and poor people at risk by practically denying them access to public health\ud
services. This applies both to (1) the exemption and waiver system in health facilities and (2) the exemption mechanisms instituted for the CHFs. In both situations, poor people just do not receive the exemptions to which they are entitled to! Revenue collection appears to prevail over protecting the poor and vulnerable. Some hospitals have even tried to hide the waivers in their statistics in order to have, on paper, a better performance with their user fee income. The study team recommends that, should the government of Tanzania decide to maintain its user fee policy, priority is given to the design of an effective exemption and waiver system combined with: (1) sufficient resources to compensate for the unknown money lost (since it not recorded properly), and (2) a serious effort to make it work. However, there is substantial evidence that exemption and waiver systems do not guarantee increased access to health services for poor people unless major adjustments in the design, implementation and funding for adequate exemption and waiver systems take place. In the light of recent developments in Uganda and Kenya, it seems a much more realistic approach to compare the costs of (1) the suspension of user fees at PHC level against the required costs for (2) improved exemption and waiver systems or (3) improved NSHIF approaches in the contest of abolishment of fees and to opt for the most pro-poor and cost-effective approach within the shortest possible time frame. The potential and impact of Community Health Funds. The introduction of the CHF has not provided the expected benefits for poor people. There are a number of constraints the study team thinks should be urgently addressed, including the delays in the introduction of the CHFs and the weak management at the district and lower levels. More importantly, the study team found that poor people often cannot afford to pay the CHF premium because it is too high and has to be paid at once. If membership of the CHF becomes compulsory and poor people are not effectively exempted from paying CHF premiums and co-payments, the impact of the CHF can be disastrous and lead to double exclusion of poor people. Another issue of concern is related to the link between user fees and the CHF. According to the CHF Act, the user fees paid at public health centres and dispensaries form a source of income to the CHF. The premium paid to the CHF will receive WB matching funds, putting pressure on the PHC facilities to raise income through user fees. This indicates a complicated dilemma since it means that if user fees will be suspended or abolished at PHC level, the CHFs will not be able to take off as planned and will not receive part of their required resources. This points to the need to assess the mix of financing mechanisms and their interactions, rather than look at them as stand-alone policies. Tanzania has opted for a system of multiple risk-pooling schemes for the health sector. There is an urgent need to review the ongoing processes and assess their impact on the overall health system and the vulnerable members of the population. Scenarios. Reviewing the available literature, the study team observes that the abolition of user fees for education in Tanzania, and for health in South Africa and Uganda, has had impressive results in terms of attendance and access. Recently, Kenya also decided to abolish user fees for health. However, when reviewing the stakeholder’s attitudes towards abolition, the study team concludes that the necessary support for such a decision seems to lacking in Tanzania at present. The study shows that Tanzania is at a cross road. Tanzania can opt for two strategic directions. One strategy can be to continue on the road of the multiple risk pooling strategies. The other strategy can be to follow the abolishment of user fees at either (1) all levels or (2) at PHC levels. Both strategies will require substantial support from external donors and will require major adjustments in the current funding mechanisms. However, given the negative equity implications for poor people with the multiple risk pooling systems and the complicated, time consuming, costly and unreliable administration that is required for user fee systems and CHF, evidence indicates that it seems a more pro-poor and pragmatic strategy to abolish the user fees for poor people either (1) temporarily till improved exemption and waiver systems have been designed and introduced or (2) as long as the poverty situation in Tanzania requires. In case Tanzania will opt for the continuation of a multiple risk pooling system, then a number of key conditions will have to be met in order to ensure access to health services for poor people. It will be crucial to assess the mix of financing mechanisms and their interactions rather than look at them as stand-alone policies. Considering the severe poverty situation in Tanzania, it is concerning to find that many stakeholders continue promoting and supporting user fees in the absence of effective exemption and waiver systems. This does not correspond with the commitment to reducing poverty in Tanzania as articulated in the PRS. Consequently, immediate political action is required. Abolition of user fees can be considered as a pro-poor option to reduce exclusion and self-exclusion among the poor and vulnerable. The studies illustrate, that the abolition of fees needs to be combined with considerable efforts in other areas, such as changed levels of funding (internally and externally), improvements in the allocation and disbursement of funds, improved human resource development, improved incentive schemes for health workers and improved quality of services. This indicates the importance of a broad, strong political support and donor support. The developments in Uganda and Kenya might have created a momentum for Tanzania to rethink the current multiple risk pooling strategies in the context of the PRS Review and to opt for more pro-poor health strategies. It should be noted that in the current political situation strengthening the existing exemption and waiver systems seems to be the most preferred scenario at this moment. However, in the light of all the constraints mentioned and in the context of positive developments in Uganda and recent decisions taken in Kenya, the study team would like to recommend to include the suspension of user fees at PHC level in the next PRS document for Tanzania as a real pro-poor health strategy for Tanzania. The study team considers the Poverty Reduction Strategy Review Process as an excellent opportunity to lobby the government and the development partners on these issues, and to demand that a specific Plan of Action is included in the second Poverty Reduction Strategy Paper. The study team hopes that the findings of this study will contribute in such a positive and constructive way to the Tanzania PRS Review Process. The outcomes of this study confirm that in Tanzania, user fees are an issue to be carefully (re)considered when designing national pro-poor health policies in Poverty Reduction Strategies. Considering the severe poverty situation in Tanzania, it is concerning to find that many stakeholders\ud
continue promoting and supporting user fees in the absence of effective exemption and waiver systems. This does not correspond with the government’s commitment to reduce poverty in Tanzania. Consequently, immediate political action is required.\u
Towards developing an atmospheric space for inter-religious dialogue in Africa
No full textDATA AVAILABILITY : Data sharing is not applicable to this article as no new data
were created or analysed in this study.The author/s is participating in the research project, ‘Religion, Theology and Education’, directed by Prof. Dr Jaco Beyers, Head of Department Religion Studies, Faculty of Theology and Religion, University of Pretoria.Special Collection: Interreligious Dialogue, sub-edited by Jaco Beyers (University of Pretoria, South Africa).The practice of religions and spirituality is common in Africa. In many ways, religion may
be considered as a routine of life, living and practising it either as inherited or borrowed.
Religious pluralism is a reality in Africa, dating back to the 1st century up to the 19th
century when Africa became a bedrock of traders and colonisers both from Europe and
Asia. The paper explores plural religiosity with a view to developing a conducive
atmosphere that may promote a suitable inter-religious dialogue in Africa. Largely, the
most pronounced and practised religions are Christianity symbolised by the cross, Islam
symbolised by the crescent, and African indigenous religion that does not have a common
symbol nor sacred scriptures. We note that, for generations, religions have caused division
among communities, but have in the recent years developed the quest to create good
relations and dialogue with each other. Because of the diverse nature of insecurity in Africa,
it is hoped that inter-religious dialogue may cause community cohesion, integration,
inclusivity, and co-existence. In the wake of different types of inter-religious dialogue that
are globally being researched, this paper suggests a specific inter-religious dialogue that
Africans can exercise: ‘dialogue for life’.
CONTRIBUTION : Inter-religious dialogue for life is contextual in that, it touches upon the life
situations of ordinary people in society. The author argues that, by embracing it religiously,
inter-religious dialogue for life shall address crucial issues such as poverty, radicalisation,
terrorism, climate change, bad governance, and human trafficking that adversely affect
African society.http://www.hts.org.zaam2024Science of Religion and MissiologyNon
Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries
No full textAlthough the Human Resources for Health (HRH) crisis is apparently not
new in the public health agenda of many countries, not many low and
middle income countries are using Primary Health Care (PHC) as a tool
for planning and addressing the crisis in a comprehensive manner. The
aim of this paper is to appraise the inadequacies of the existing
planning approaches in addressing the growing HRH crisis in resource
limited settings. A descriptive literature review of selected case
studies in middle and low income countries reinforced with the evidence
from Tanzania was used. Consultations with experts in the field were
also made. In this review, we propose a conceptual framework that
describes planning may only be effective if it is structured to embrace
the fundamental principles of PHC. We place the core principles of PHC
at the centre of HRH planning as we acknowledge its major perspective
that the effectiveness of any public health policy depends on the
degree to which it envisages to address public health problems
multidimensionally and comprehensively. The proponents of PHC approach
in planning have identified intersectoral action and collaboration and
comprehensive approach as the two basic principles that policies and
plans should accentuate in order to make them effective in realizing
their pre-determined goals. Two conclusions are made: Firstly,
comprehensive health workforce planning is not widely known and thus
not frequently used in HRH planning or analysis of health workforce
issues; Secondly, comprehensiveness in HRH planning is important but
not sufficient in ensuring that all the ingredients of HRH crisis are
eliminated. In order to be effective and sustainable, the approach need
to evoke three basic values namely effectiveness, efficiency and
equity
Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries
No full textAlthough the Human Resources for Health (HRH) crisis is apparently not
new in the public health agenda of many countries, not many low and
middle income countries are using Primary Health Care (PHC) as a tool
for planning and addressing the crisis in a comprehensive manner. The
aim of this paper is to appraise the inadequacies of the existing
planning approaches in addressing the growing HRH crisis in resource
limited settings. A descriptive literature review of selected case
studies in middle and low income countries reinforced with the evidence
from Tanzania was used. Consultations with experts in the field were
also made. In this review, we propose a conceptual framework that
describes planning may only be effective if it is structured to embrace
the fundamental principles of PHC. We place the core principles of PHC
at the centre of HRH planning as we acknowledge its major perspective
that the effectiveness of any public health policy depends on the
degree to which it envisages to address public health problems
multidimensionally and comprehensively. The proponents of PHC approach
in planning have identified intersectoral action and collaboration and
comprehensive approach as the two basic principles that policies and
plans should accentuate in order to make them effective in realizing
their pre-determined goals. Two conclusions are made: Firstly,
comprehensive health workforce planning is not widely known and thus
not frequently used in HRH planning or analysis of health workforce
issues; Secondly, comprehensiveness in HRH planning is important but
not sufficient in ensuring that all the ingredients of HRH crisis are
eliminated. In order to be effective and sustainable, the approach need
to evoke three basic values namely effectiveness, efficiency and
equity
Equity implications of health sector user fees in Tanzania analysis of literature and stakeholder views ; study period March - May 2004 ; final report
No full textContestations over Caprivi identities : from pre colonial times to the present
No full textIncludes abstract.Includes bibliographical references.This study investigated the hypothesis that Caprivi identities exist; and that they have always been contested. These identities defined as a sense of not belonging to greater South West Africa exist in two forms: i) as a spatial or geographical entity usually divided into East and West in history for administrative purposes; and, ii) as a people, such as Subia, Mafwe, Mayeyi, Mbukushu, Barakwena, Totela, Mbalangwe, and Lozi, collectively referred to as ‘Caprivians’. Through utilizing primary sources such as oral interviews and archival material as well as secondary sources, the study endeavored to establish how Caprivi identities were constructed; what the nature of its contestations are; and how ‘Caprivians’ responded to its construction. It was established that Caprivi identities were the result of administrative neglect in state formation that constructed isolation on the basis of difference – that ‘Caprivians’ are different from other groups in South West Africa, and that Caprivi was geographically remote from Windhoek and hence difficult to administer as part of South West Africa. Resultantly, only a primitive form of indirect rule existed in the area for most part of its colonial history resulting in constant change of colonial masters. Though it was pushed more to neighboring territories administratively, it was not made an integral part of such territories but made to stand separate as a geographical entity
