Challenges in Managing Health Workers in Sub-Saharan Africa: The Case of United Republic of Tanzania

This study documents results of four years (2009-2013) of implementation activities under the Tanzania Human Resource Capacity Project (THRP), a USAID-funded initiative that addressed inefficiencies in the systems and structures of central government and local governments that deal with HRH in Tanzania. The initiative was a beneficial undertaking in Tanzania, a Sub-Saharan country facing the burden of a high maternal mortality rate, high incidence of malaria, HIV/AIDS and a host of other curable and preventable diseases; [1] partly due to fact that the current systems and structures that manage HRH are not responsive enough to the insufficient FTE's and low productivity of HRH. In 2009, the health system in Tanzania operated with 48 percent of the optimum workforce; in rural areas the vacancy rates reached up to 70 percent, threatening to negate national efforts to universal health care and health development goals [2, 3]. The THRP was, therefore, conceived to contribute to the realization of goals of the national HRH Strategic Plan for 2008 -2013 by influencing and contributing to multi-sectoral efforts to strengthen the planning, deployment, management and efficient utilization of human resources. The purpose of this paper is to describe overall strategic objectives of the project, the intermediate results, and to describe strategies that contributed to each of the project objectives. Key leadership challenges and lessons learned included: • A Knowledge gap within the RHMTs on CCHPs and PlanRep3 tools, a computer based planning tool used by PMO-RALG, has resulted in poor quality of initial plans submitted by LGAs many of which were mitigated by retraining and follow-up online support. • Increased workload for HR officers and other Local Government/Human Resource Information Systems (LGHRIS/HRIS) users due to the existence of multiple systems (HCMIS and HRHRIS) using the same staff for data entry and update of which the systems interoperability initiatives helped ease management burden and created resource sharing opportunities including data, computing infrastructure and capacity building. • LGAs/Councils willingness to seek and budget for HRM/HRIS/MVC resource despite their deficit; once they were sensitized, understood and owned the project activities/outcomes. • Lack of computing and connectivity infrastructure which was mitigated through partial provision of equipment and co-sharing to cover the missing items. Key workable sustainability strategies included: • Capacity building embodied as part of HRM/HRIS/MVC project activities, thus creating independent capabilities to manage and support the systems • Through USAID funding, THRP initially deployed the system to 91 LGAs and RSs. When this was successfully accomplished, PMO-RALG developed a cost sharing arrangement with IntraHealth to extend the deployment to the rest of LGAs and RSs in Tanzania, making a total of 154 LGAs and 21 RS offices with fully installed systems. This extension signaled a state of high demand and readiness and encouraged GOT ownership of the system. • Through THRP, the UDSM-CSD and the CapacityPlus Initiative, the project organized an international HRIS open source training for Sub-Saharan Africa countries in Dar es Salaam this year as part of regional HRIS capacity building. THRP has significantly contributed to bridging the HRH gap from over 50 per cent in the past four years to the current 40 per cent status [14]. Overall, the THRP initiative is a model that could be replicated in countries where such efforts are not yet on the ground in order to attain health related millennium development goals and other better health outcomes.Master of Public Healt

Otological emergencies among the northern Nigerian children

Background: Swift recognition and prompt institution of management is very crucial to successful outcome of otologic emergencies. The aim and objective of the study was to determine the spectrum of pediatric otologic emergencies in northern Nigeria.Methods: A retrospective study to review of 1497 paediatric otologic emergencies aged one month to 14 years seen at National ear care centre, Kaduna between 2002 and 2006 inclusive was done. The records of all these patients were retrieved, studied and information collected analyzed. The data extracted for analysis included – biodata, clinical presentation diagnosis and treatment outcome.Results: There were 943 male and 554 female with M: F ratio of 1.7:1. Their ages ranged from 1month to 14 years with a mean age of 4.95years (SD=4.15). A total of 928 (62%) were infants and preschool age groups (under fives). Acute suppurative otitis media was found in 573 (38.3%), was the commonest otological condition diagnosed followed by acute otitis media in 22.6% and foreign body in the ear in 222(14.8%).The least frequent were CSF otorrhea, and ramsay hunt disease which constituted 0.07%.Conclusion: Acute suppurative otitis media, acute otitis media and foreign body insertion into the ear still constitute the common otological emergencies in Northern Nigeria. These are all preventable emergencies through community health education, training of community health worker to recognize the symptom and signs of ear disease with early referral

Challenges for Malaria Elimination in Zanzibar: Pyrethroid Resistance in Malaria Vectors and Poor Performance of Long-Lasting Insecticide Nets.

Long-lasting insecticide treated nets (LLINs) and indoor residual house spraying (IRS) are the main interventions for the control of malaria vectors in Zanzibar. The aim of the present study was to assess the susceptibility status of malaria vectors against the insecticides used for LLINs and IRS and to determine the durability and efficacy of LLINs on the island. Mosquitoes were sampled from Pemba and Unguja islands in 2010--2011 for use in WHO susceptibility tests. One hundred and fifty LLINs were collected from households on Unguja, their physical state was recorded and then tested for efficacy as well as total insecticide content. Species identification revealed that over 90% of the Anopheles gambiae complex was An. arabiensis with a small number of An. gambiae s.s. and An. merus being present. Susceptibility tests showed that An. arabiensis on Pemba was resistant to the pyrethroids used for LLINs and IRS. Mosquitoes from Unguja Island, however, were fully susceptible to all pyrethroids tested. A physical examination of 150 LLINs showed that two thirds were damaged after only three years in use. All used nets had a significantly lower (p < 0.001) mean permethrin concentration of 791.6 mg/m2 compared with 944.2 mg/m2 for new ones. Their efficacy decreased significantly against both susceptible An. gambiae s.s. colony mosquitoes and wild-type mosquitoes from Pemba after just six washes (p < 0.001). The sustainability of the gains achieved in malaria control in Zanzibar is seriously threatened by the resistance of malaria vectors to pyrethroids and the short-lived efficacy of LLINs. This study has revealed that even in relatively well-resourced and logistically manageable places like Zanzibar, malaria elimination is going to be difficult to achieve with the current control measures

Plasma Insulin Pattern in a Hausa-Fulani Ethnic Group in Northern Nigeria

Background: Plasma insulin levels seem to play significant roles in health and disease; and prevailing plasma insulin levels are modulated by racial and ethnic factors. There has been no previous study of the plasma insulin pattern in any northern Nigerian tribe. Methods: Thirty-six (24 males and 12 females) healthy volunteers of a northern Nigerian tribe were studied. Fasting plasma insulin and glucose levels were estimated; this was followed by a standard OGTT to study the plasma insulin response to oral glucose challenge. Results: Although there were marked individual variations with 16.7% of individuals demonstrating fasting hyperinsulinaemia, mean fasting plasma insulin levels were similar to those earlier reported elsewhere. Conclusion: These findings are discussed in view of other factors known to modulate plasma insulin level

The prevalence of hyperthyroidism at university of maiduguri teaching hospital (UMTH), Maiduguri.

Hyperthyroidism and hypothyroidism are the two common thyroid disorders but there is paucity of information on the prevalence of hyperthyroidism in Nigeria in general and in Northeast of Nigeria in particular. Objective: To determine the prevalence of hyperthyroidism at University of Maiduguri Teaching Hospital. Method: A retrospective study done over a period of one year that reviews the results of serum TSH, T4 and T4 from 203 patients. Results: Eighty-nine (43.8%) and 79 (38.9%) patients had elevated serum levels of T3 and T4 respectively (i.e. were hyperthyroid), 114 (56.2%) and 112 (55.2%) patients had normal serum levels of T3 and T4 respectively (i.e. were euthyroid) while 12 (5.9%) patients had low serum levels of T4 only (i.e. were hypothyroid). The female to male ratio of hyperthyroidism was 4 and 1[T3 — female 68 (35.4%), male — 17(89%); T 4— female 59 (30.7%), male 15(7.8%)]. Age —group from 25—34 years was the most frequent. (51 patients) and with the highest prevalence of hyperthyroidism [T4- 19(14.2%); T4&nbsp;18(13.4%)].The study further revealed a decline in the prevalence of hyperthyroidism as age increased. The finding of high prevalence of low TSH (20.8%) against high prevalence of elevated T3 and T4 [89(44.1% and 79(38.9%) respectively] in this study could suggest that the hyperthyroidism in the studied patients could have been largely caused by Graves' disease. Conclusion: This study revealed that thyroid disorders are not uncommon in our environment and the finding of high prevalence of low TSH above high TSH, suggested that the hyperthyroidism discovered in our study may have been largely caused by Grave's disease. We recommend that more laboratory diagnostic centre should be established in our environment where thyroid disorders can be diagnosed

Induced spawning and larval rearing of the sea cucumber Holothuria nobilis

Sea cucumber Holothuria nobilis is an economically important species for livelihoods in many countries. However, an increase in demand for this species has led to the depletion of wild stocks. The introduction of this species in aquaculture is necessary to reduce fishing pressure. This study was taken to establish breeding and larval rearing techniques for the development of H. nobilis aquaculture. The broodstock collected from the wild were induced to spawn by using thermal stimulation and the combination of thermal and algal stimulation methods. The larvae obtained from induced spawning were reared using different diets (mixed microalgae and mixed microalgae with artificial feeds) at different stocking densities (300, 600, and 1000 larvae/l). Thermal stimulation is the best method of inducing spawning to H. nobilis yielding up to 1,300,000 fertilized eggs. The highest survival rate (27.5%) of doliolaria larvae was achieved using a mixed microalgae diet. The highest survival rate of doliolaria larvae (41.5 %), growth, and development were in the stocking density of 600 larvae/l

Girl Trafficking: Causes, Experiences and Challenges encountered A case of Arusha Municipality

Persistence of human trafficking in Tanzania is reported to be exacerbated by many factors including patriarchal systems, poverty, peer influences, job opportunities and availability of social services to mention a few. Deprivation of capabilities however, has been thought to catalyze the situation more as compared to others. In a research conducted in Arusha Municipality involving girls who are victims of human trafficking and other stakeholders;  it was found out that destitution of rural families, forced marriages, peer influences, broken families and gender based violence were among the root causes which rendered these young girls become preys to traffickers.  Further the study found out that these young girls faced a lot of challenges including being overworked and being unpaid, being tortured physically and sometimes emotionally. Complementing these challenges the girls lamented on sexual abuse and even disease which they encounter. In combating the situation the study recommends more drastic measures to the Government and other stakeholders including increasing awareness in Human Trafficking to the general public and encourages victims to report the cases. Additionally it recommends that children who are most vulnerable and at high risk of being trafficked be checked regularly and if possible be supplied with the basic needs. Key words: Gender based violence, Human trafficking, Poverty, Trafficking in childre