30 research outputs found
Implementation of an insecticide-treated net subsidy scheme under a public-private partnership for malaria control in Tanzania--challenges in implementation.
No full textBACKGROUND: In the past decade there has been increasing visibility of malaria control efforts at the national and international levels. The factors that have enhanced this scenario are the availability of proven interventions such as artemisinin-based combination therapy, the wide scale use of insecticide-treated nets (ITNs) and a renewed emphasis in indoor residual house-spraying. Concurrently, there has been a window of opportunity of financial commitments from organizations such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), the President's Malaria Initiative and the World Bank Booster programme. METHODS: The case study uses the health policy analysis framework to analyse the implementation of a public-private partnership approach embarked upon by the government of Tanzania in malaria control - 'The Tanzania National Voucher Scheme'- and in this synthesis, emphasis is on the challenges faced by the scheme during the pre-implementation (2001 - 2004) and implementation phases (2004 - 2005). Qualitative research tools used include: document review, interview with key informants, stakeholder's analysis, force-field analysis, time line of events, policy characteristic analysis and focus group discussions. The study is also complemented by a cross-sectional survey, which was conducted at the Rufiji Health Demographic Surveillance Site, where a cohort of women of child-bearing age were followed up regarding access and use of ITNs. RESULTS: The major challenges observed include: the re-introduction of taxes on mosquito nets and related products, procurement and tendering procedures in the implementation of the GFATM, and organizational arrangements and free delivery of mosquito nets through a Presidential initiative. CONCLUSION: The lessons gleaned from this synthesis include: (a) the consistency of the stakeholders with a common vision, was an important strength in overcoming obstacles, (b) senior politicians often steered the policy agenda when the policy in question was a 'crisis event', the stakes and the visibility were high, (c) national stakeholders in policy making have an advantage in strengthening alliances with international organizations, where the latter can become extremely influential in solving bottlenecks as the need arises, and (d) conflict can be turned into an opportunity, for example the Presidential initiative has inadvertently provided Tanzania with important lessons in the organization of 'catch-up' campaigns
Politics, Child Mortality, and Health System Development in Tanzania and Uganda, 1995-2009.
No full textSub-Saharan African countries have diverged sharply in health status in recent years: Some have reduced premature mortality rapidly while others have made little progress, despite significant health-oriented foreign aid. This article identifies political economy and institutional factors that help explain dramatic differences in the pace of child mortality reduction between Tanzania and Uganda from 1995-96 to 2006-07. The existing literature largely explains divergence in basic health outcomes like child mortality with reference to economic variables such as GDP per capita, or in terms of inputs such as the level of public sector health spending. However, these factors cannot explain recent divergence across African countries with similar levels of GDP per capita, rates of economic growth, and levels of health funding. I argue that in addition to economic factors, governance-related variables can play a large role in determining health outcomes. I argue that institutional and governance divergences between Tanzania and Uganda can be linked directly to differing levels of coverage of key child health interventions (especially related to malaria control), and thus to differing child health outcomes. These governance-related divergences are found in the institutional dynamics of malaria control, in the degree of meritocracy and bureaucratic autonomy found at the Ministry of Health, in the political economy of health sector decentralization, and in corruption levels in the pharmaceutical supply chain. These institutional differences can be explained in part by historical factors, but the more relevant causes can be found in recent years. In Tanzania, there was an unusually effective project of institution-building in the health sector, centered on malaria policy and research institutions, and on district-level reforms driven by use of demographic surveillance systems. In Uganda, by contrast, there was a negative political shock to the health system, driven by the repatrimonialization of the Ugandan state after President Yoweri Museveni’s decision to eliminate term limits in the 2001-2006 period and embark on the “president-for-life project.” This repatrimonialization process reversed previous health sector institutional gains and had particularly negative effects on child health service delivery in Uganda
Pengaruh Spirit Of Entrepreneur terhadap Kinerja Usaha Para Pelaku UKM Tenant Pusat Inkubator Bisnis Cikal USU
No full textThis study aims to identify and analyze the effect of Spirit Of Entrepreneur
On Performance Business The Actors SME Tenant Pusat Inkubator Bisnis Cikal
USU is located at Jl. Dr. Mansur No. 9B Campus University of North Sumatra.
This research includes the study associative. The data used in this study is
primary data and secondary data. The population in this study are all ownwd by
Tenant SME Pusat Inkubator Bisnis Cikal USU, with respondent total as much as
70 respondents. Hypothesis testing at do by using doubled linear regression
analysis with free variable, that is Self-Directed, Self-Nurturing, Action-Orientd,
Highly-Energic,Tolerant of Uncertainty, Technological Change, Structure change
of Government and Politics, Intrapreneurship and bound variable that is Business
Performance.
The results showed that the independent variables simultaneously positive
and significant effect on the dependent variable. Based on the test results the
coefficient of determination (R2), the value of R Square of 0.633 means 63.3%
Business Performance variables can be explained by the variable Self-Directed,
Self-Nurturing, Action-Oriented, Highly-Energic, Tolerant of Uncertainty,
Technological Change, Structure change of Government and Politics, and
Intrapreneurship, while the remaining 36.7% is explained by other variables not
examined in this study. Effect of Spirit Of Entrepreneur which author researched
showed a tight relationship that is equal to 79.6%118 HalamanSkripsi Sarjan
Training needs assessment of community action for development and environment conservation trust - Arusha
No full textThis is a Training Needs Assessment (TNA) project: the case of CADECT CBO. The assessment came as a request of group leaders on conducting training on skills for community raining and facilitation. The assessment is an analysis of current training needs of the group. It is essentially based on primary data from the field i.e. group members, and it is closely related to works done by scholars involved in training and adult learning such as Frank et al (1978), Silberman (1996), Gajanayake (1986) and Prahad et al (1992) who have dwelt on how the community and organizations can be empowered in terms of skills so that to reach a common goal of development.
From CADECT's project implementation reports of 2002 and 2003, it was noted that there was a problem of failure to involve more community members in the development projects implemented in the community. It is four years now since the organization started its operations. Problems of unsanitary, seasonal hunger, low incomes, and environmental degradation have been insignificantly eliminated from the village. According to group leaders, there had been no formal training to the group on how to train the community regarding different developmental issues. It was observed that projects have been implemented by few people who are mostly members of the group. This might be due to lack of transfer of knowledge and experience from the group members to the rest of the community members, lack of awareness, lack of training and lack of confidence of the group members responsible for awareness creation among the community members.
A population of twenty one (21) group members was expected but only twenty (20) were reached. This was 96% of the expected population.
Findings showed that the group needed trainings in community training and facilitation skills, HIV/AIDS, Rain water harvesting, Food storage and preservation systems, training on Income generating activities, Environmental conservation training and Cleanliness and hygiene training.
A training package on community training and facilitation skills was prepared and four leaders of the group were trained to build their capacity in training the rest of group members.
The following was recommended:
Relevant and result based trainers/facilitators course should be conducted to group members for them to be able to train the community members on different projects and other developmental issues.
The group needs a refresher course in HIV/AIDS to be in a better position to disseminate relevant messages on the disease to the community.
The group need capacity building in issues of people's participation and bottom up approaches so as they may get away with dependency mentality.
The community should identify potential resources in the area (land, animals etc) so that they may be utilized effectively to improve incomes of the community members.
The group and community at large should be trained on practices which delays project implementation.
Heavy punishment should be given to those who misuse funds donated for projects for the community of Mkonoo. (Author abstract)Mgullo, R. J. (2005). Training needs assessment of community action for development and environment conservation trust - Arusha. Retrieved from http://academicarchive.snhu.eduMaster of Science (M.S.)School of Community Economic Developmen
Policy Analysis for Deciding on a Malaria Vaccine RTS,S in Tanzania
No full textTraditionally, it has taken decades to introduce new interventions in low-income countries. Several factors account for these delays, one of which is the absence of a framework to facilitate comprehensive understanding of policy process to inform policy makers and stimulate the decision-making process. In the case of the proposed introduction of malaria vaccines in Tanzania, a specific framework for decision-making will speed up the administrative process and shorten the time until the vaccine is made available to the target population. Qualitative research was used as a basis for developing the Policy Framework. Interviews were conducted with government officials, bilateral and multilateral partners and other stakeholders in Tanzania to assess malaria treatment policy changes and to draw lessons for malaria vaccine adoption. The decision-making process for adopting malaria interventions and new vaccines in general takes years, involving several processes: meetings and presentations of scientific data from different studies with consistent results, packaging and disseminating evidence and getting approval for use by the Ministry of Health and Social Welfare (MOHSW). It is influenced by contextual factors; Promoting factors include; epidemiological and intervention characteristics, country experiences of malaria treatment policy change, presentation and dissemination of evidence, coordination and harmonization of the process, use of international scientific evidence. Barriers factors includes; financial sustainability, competing health and other priorities, political will and bureaucratic procedures, costs related to the adoption and implementations of interventions, supply and distribution and professional compliance with anti-malarial drugs. The framework facilitates the synthesis of information in a coherent way, enabling a clearer understanding of the policy process, thereby speeding up the policy decision-making process and shortening the time for a malaria vaccine to become available
Public health review : creating an enabling environment for taking insecticide treated nets to national scale; the Tanzanian experience
No full textMalaria is the major single cause of health service attendances, hospital admissions and child deaths in Tanzania and a major impediment to social and economic development in the country. Despite the heavy health, social and economic burden efforts to support malaria control have been inadequate. With the advent of Insecticide Treated Nets (ITNs) as a tool for malaria control, the Roll Back Malaria Initiative launched in 1998 advocated renewed emphasis on sustainable preventive measures. Tanzania committed itself at the Summit of African Heads of State in Abuja in April 2000 to protect 60% of its population at high risk by 2005. The country is therefore determined to ensure that sustainable malaria control using ITNs is carried out at national scale. // Tanzania has been involved for two decades in the research process for developing ITNs as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. To this effect, a number of small and large-scale implementation projects have taken place. Since 2000 the emphasis has changed from a project approach to that of a concerted multistakeholder action for taking high coverage of ITNs to national scale. This means creating conditions that make ITNs accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania’s experience in creating an enabling environment for ITN scale-up, and reviews the numerous important issues that need to be considered in making this vision a reality
Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience.
No full textINTRODUCTION: Malaria is the largest cause of health services attendance, hospital admissions and child deaths in Tanzania. At the Abuja Summit in April 2000 Tanzania committed itself to protect 60% of its population at high risk of malaria by 2005. The country is, therefore, determined to ensure that sustainable malaria control using insecticide-treated nets is carried out on a national scale. CASE DESCRIPTION: Tanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004. CONCLUSION: National upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries
Susceptibility Status of Malaria Vectors to Insecticides Commonly used for Malaria Control in Tanzania.
No full textThe aim of the study was to monitor the insecticide susceptibility status of malaria vectors in 12 sentinel districts of Tanzania. WHO standard methods were used to detect knock-down and mortality in the wild female Anopheles mosquitoes collected in sentinel districts. The WHO diagnostic doses of 0.05% deltamethrin, 0.05% lambdacyhalothrin, 0.75% permethrin and 4% DDT were used. The major malaria vectors in Tanzania, Anopheles gambiae s.l., were susceptible (mortality rate of 98-100%) to permethrin, deltamethrin, lambdacyhalothrin and DDT in most of the surveyed sites. However, some sites recorded marginal susceptibility (mortality rate of 80-97%); Ilala showed resistance to DDT (mortality rate of 65% [95% CI, 54-74]), and Moshi showed resistance to lambdacyhalothrin (mortality rate of 73% [95% CI, 69-76]) and permethrin (mortality rate of 77% [95% CI, 73-80]). The sustained susceptibility of malaria vectors to pyrethroid in Tanzania is encouraging for successful malaria control with Insecticide-treated nets and IRS. However, the emergency of focal points with insecticide resistance is alarming. Continued monitoring is essential to ensure early containment of resistance, particularly in areas that recorded resistance or marginal susceptibility and those with heavy agricultural and public health use of insecticides
Use of insecticide quantification kits to investigate the quality of spraying and decay rate of bendiocarb on different wall surfaces in Kagera region, Tanzania
No full textBendiocarb was introduced for the first time for Indoor Residual Spraying (IRS) in Tanzania in 2012 as part of the interim national insecticide resistance management plan. This move followed reports of increasingly alarming levels of pyrethroid resistance across the country. This study used the insecticide quantification kit (IQK) to investigate the intra-operational IRS coverage and quality of spraying, and decay rate of bendiocarb on different wall surfaces in Kagera region.; To assess intra-operational IRS coverage and quality of spraying, 104 houses were randomly selected out of 161,414 sprayed houses. A total of 509 samples (218 in Muleba and 291 in Karagwe) were obtained by scraping the insecticide samples from wall surfaces. To investigate decay rate, 66 houses (36 in Muleba and 30 in Karagwe) were selected and samples were collected monthly for a period of five months. Laboratory testing of insecticide concentration was done using IQK(TM) [Innovative Vector Control Consortium].; Of the 509 samples, 89.5% met the World Health Organization (WHO) recommended concentration (between 100-400 mg/m(2)) for IRS target dosage. The proportion of samples meeting WHO standards varied between Karagwe (84.3%) and Muleba (96.3%) (p > 0.001). Assessment of quality of spraying at house level revealed that Muleba (84.8%) had a significantly higher proportion of households that met the expected target dosage (100-400 mg/m(2)) compared to Karagwe (68.9%) (p > 0.001). The quality of spraying varied across different wall substrates in both districts. Evaluation of bendiocarb decay showed that the proportion of houses with recommended concentration declined from 96.9%, 93.5% and 76.2% at months one, two, and three post IRS, respectively (p-trend = 0.03). The rate of decay increased in the fourth and fifth month post spraying with only 55.9% and 26.3% houses meeting the WHO recommendations, respectively. IQK is an important tool for assessing IRS coverage and quality of spraying. The study found adequate coverage of IRS; however, residual life of bendiocarb was observed to be three months. Results suggest that in order to maintain the recommended concentrations with bendiocarb, a second spray cycle should be carried out after three months
High cure rates and tolerability of artesunate–amodiaquine and dihydroartemisinin–piperaquine for the treatment of uncomplicated falciparum malaria in Kibaha and Kigoma, Tanzania
No full textAbstract Background The Tanzanian National Malaria Control Programme (NMCP) and its partners have been implementing regular therapeutic efficacy studies (TES) to monitor the performance of different drugs used or with potential use in Tanzania. However, most of the recent TES focused on artemether–lumefantrine, which is the first-line anti-malarial for the treatment of uncomplicated falciparum malaria. Data on the performance of other artemisinin-based combinations is urgently needed to support timely review and changes of treatment guidelines in case of drug resistance to the current regimen. This study was conducted at two NMCP sentinel sites (Kibaha, Pwani and Ujiji, Kigoma) to assess the efficacy and safety of artesunate–amodiaquine (ASAQ) and dihydroartemisinin–piperaquine (DP), which are the current alternative artemisinin-based combinations in Tanzania. Methods This was a single-arm prospective evaluation of the clinical and parasitological responses of ASAQ and DP for directly observed treatment of uncomplicated falciparum malaria. Children aged 6 months to 10 years and meeting the inclusion criteria were enrolled and treated with either ASAQ or DP. In each site, patients were enrolled sequentially; thus, enrolment of patients for the assessment of one artemisinin-based combination was completed before patients were recruited for assessment of the second drugs. Follow-up was done for 28 or 42 days for ASAQ and DP, respectively. The primary outcome was PCR corrected cure rates while the secondary outcome was occurrence of adverse events (AEs) or serious adverse events (SAEs). Results Of the 724 patients screened at both sites, 333 (46.0%) were enrolled and 326 (97.9%) either completed the 28/42 days of follow-up, or attained any of the treatment outcomes. PCR uncorrected adequate clinical and parasitological response (ACPR) for DP on day 42 was 98.8% and 75.9% at Kibaha and Ujiji, respectively. After PCR correction, DP’s ACPR was 100% at both sites. For ASAQ, no parasite recurrence occurred giving 100% ACPR on day 28. Only one patient in the DP arm (1.1%) from Ujiji had parasites on day 3. Of the patients recruited (n = 333), 175 (52.6%) had AEs with 223 episodes (at both sites) in the two treatment groups. There was no SAE and the commonly reported AE episodes (with > 5%) included, cough, running nose, abdominal pain, diarrhoea and fever. Conclusion Both artemisinin-based combinations had high cure rates with PCR corrected ACPR of 100%. The two drugs had adequate safety with no SAE and all AEs were mild, and not associated with the anti-malarials. Continued TES is critical to monitor the performance of nationally recommended artemisinin-based combination therapy and supporting evidence-based review of malaria treatment policies. Trial registration This study is registered at ClinicalTrials.gov, No. NCT0343171
