Stakeholders' Participation in Planning and Priority Setting in the Context of a Decentralised Health Care system: the case of prevention of mother to child Transmission of HIV Programme in Tanzania.

In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery

Implementation of an insecticide-treated net subsidy scheme under a public-private partnership for malaria control in Tanzania – challenges in implementation

BACKGROUND: 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

Creating Indigenous Discourse: History, Power, and Imperialism in Academia, Palestinian Case

This article examines the impossibilities of implementing decolonizing research for indigenous scholars. In addition, it articulates the relationship between a decolonizing research approach and the historical and current forms of academic imperialism; a prototype of the Palestinian legacy is presented. The author argues that the current indigenous discourse is a remnant of oppression. The existing indigenous discourse is not due to the original quest but instead, it is in response to oppression. Also, the author explains the struggles of some indigenous scholars in complying with the reporting and ownership of knowledge that is required by Cartesian principles.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Equity and utilization of preventive health care services. The case of immunization completion among children 12-23 months in Kagera region Tanzania

Objective: The aim of this study was to determine factors associated with completion of immunization as an input in to strategies to raisethe immunization coverage in Tanzania.Methods: This study used a panel data collected over four survey rounds at a minimum of six months apart to determine the causes offailure to complete immunization in Tanzania. The data were collected during between 1991 and 1994 in Kagera region Tanzania amongchildren 12-23 months old. Data analysis was done using Statistical Analysis Software (SAS) version 9.1. Pooled logistic regression was usedto determine the likelihood odds ratio of completing immunization.Results: The study observed 550 children contributing 1541 children observation rounds across all panels. Immunization coverage was 87.7percent and factors that significantly (

Decolonizing cultural heritage of Indigenous people and their knowledge from images in global films

This comparative case study used a critical visual analysis approach to examine filmic stories, myths, images, and realities of the African people. Drawing on archaeology as a decolonizing practice, the study examines images and filmic representations of the Maasai of East Africa and the Himbas of Namibia. The study’s underpinnings are visual consumption theory and interpretive analysis as methods that encompass realms, such as informational processing and interpretations of images to expose the layered messages and examine the uses of cultural codes and representational conventions, deeper meanings and associations that people bring to images. The critical analysis reveals and confirms that filmic representations found in global media objectify cultural heritage in layered messages, ideologies, biases, and stereotypes, embedded in specific visual narratives about Indigenous people of Africa.

Complications of ventriculoperitoneal shunts in children in Dar es Salaam

Background: From the few reports available, VP shunt surgery in sub- Saharan Africa is associated with significant complications. This study was aimed at establishing the pattern, causes and frequency of complications of VPS in Tanzania. Methods: Sixty five of the 102 children with hydrocephalus treated with ventriculoperitoneal shunts between January 1996 and January 1999 were studied prospectively. The first follow-up was at 2 weeks postoperative when the wounds were evaluated and occipitofrontal circumference measured. Further follow-ups were at 4 weeks and at three months. Collaborating staff of the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) thereafter regularly followed up the children at home. Results: The male to female ratio was 1.8 to 1. Forty-seven of the children (72%) were less than 12 months old but no patient was under 1 month of age at operation. The mean occipitofrontal circumference was 50.7cm. Shunt blockage was the commonest complication (32.3%) followed by infection (24.6%). The combined complication rate of shunt infection and wound infection was 46.1%. Shunt-related mortality was 13 (20.0%). There was no statistically significant correlation between the occipitofrontal circumference and type of complication or mortality. The mean age among the patients showing disconnection was 21.3 months compared to a mean age of 8.1 months for those not having this complication (P-value=0.04) Conclusion: The complication rates were higher than those in Western series but compared well with findings from sub Saharan Africa other studies