The leaking pocket: The implicit struggle for skilled health workers between private not-for-profit and public sector in Tanzania

Public health services in sub-Sahara Africa countries face severe health workforce shortages exacerbated by both outward migration and internal public to private sector migration—Tanzania is no exception. This review was conducted to characterize the extent of health workforce shortages in Tanzania, and the factors impacting on the shortage. The authors reviewed publicly available data to assess the extent of health workforce shortages within Tanzania and the range of ‘pull’ and ‘push’ factors contributing to the shortages. Findings highlight significant health workforce shortages in Tanzania. Pull factors, the advantages offered that \u27pull\u27 workers towards the new jobs and well as Push factors, those negative factors that push workers out of their jobs, such as poor pay, working conditions, and management and governance issues, were identified. The issue of health workforce flow from the public to private not-for-profit sector was particularly notable and the impact this has on the ability to provide an effectively functioning public health system in Tanzania. The authors conclude that opportunities exist for the private not-for-profit sector to take an active role in the production of skilled human resources for health in Tanzania

HIV Testing for PMTCT in Tanzania: Time to move from ‘Voluntary’ to ‘Mandatory’?

Introduction: Every year many infants are infected with HIV, mostly in sub Saharan Africa. This is predominantly attributed to mother-to-child or “vertical” transmission during pregnancy, labor and delivery, and breastfeeding. Advances in antiretroviral therapy (ART) and funding have made the prevention of mother-to-child transmission (PMTCT) of HIV more affordable in sub-Saharan Africa. However, despite this advance and its potential in PMTCT, the uptake of HIV testing among pregnant women as an entry point to PMTCT services remains unsatisfactory in many countries. Methods & Results: In the present paper, authors’ present a viewpoint that supports mandatory HIV testing for pregnant women and argue that a mandatory HIV testing policy should be adopted in Tanzania. The ongoing debate about implementing mandatory pregnant women is discussed in terms of a parental obligation towards protecting a newborn child. Evidence for mandatory HIV testing in prisons e.g. for prostitution related crimes and sexual offenses, as well which the legal framework in Tanzania could support mandatory testing is discussed. Conclusion: Authors’ highlight how a national policy of mandatory HIV testing will increase the enrollment of pregnant women into PMTCT services, minimize the risk of HIV transmission to newborn children, improve health outcomes for both parents and children, and contribute to reducing the burden on limited health )resources

Improving Women and Family’s Health through Integrated Microfinance, Health Education and Promotion in Rural Areas

While increasing number of women enjoys more freedom and power in urban areas, women in rural areas are at a disadvantage in almost all aspects of life when compared to men. Investing in economic empowerment of women particularly in rural areas by supporting them to implement local context based business ideas and basic finance capacity and skills development may reverse these trends, however, when combined with heath education and promotion through trainings focusing on preventive health yields greater impact. This paper is a systematic review of the peer - reviewed research papers and project reports in English language on how rural women, children and family’s health can be improved through integrating income generation and health education & promotion activities. Generally, integrated microfinance, health education and promotion activities has resulted in significant reduction of intimate-partner violence, reduction in HIV/AIDS risk, promotion of mental health and improved women and family health. The findings may guide the process of designing and planning of integrated programs for sustainable women’s income and family health especially in rural areas

The Dangers of Being Old in Rural Tanzania: A Call for Interventions for Strengthening Palliative Care in Low-Income Communities

Tanzania is currently implementing political reforms that, with time, are expected to improve quality of life among individuals regardless of their age. This improvement in quality of life, consequently prolonged life expectancy implies that the aging population will significantly increase in a few years to come. Research projects that the number of people aged 60 years and above will increase from the current 4- percent to 10-percent of the total population by 2050 (United Republic of Tanzania, 2003; Kivelia and Kirway, 2011; Morrissette andWane, 2012). The projected increase suggests that the older population will be at a disadvantage because majority of older people in Tanzania resides in rural areas where financial support and access to social services including Primary Health Care (PHC) services is often limited (Kivelia and Kirway, 2011; Morrissette and Wane, 2012; Sanga, 2013; Musa, 2016). The older population in Tanzania continues to form a significant percentage of people seeking care for chronic diseases in PHC facilities. Reports indicate that older patients (aged 60 years and above) contribute significantly to aging related diseases, for instance, cardiovascular diseases (United Republic of Tanzania, 2007; UNFPA, 2009; Isangula andMeda, 2017). The prevalence of hypertension in Tanzania for example, is much higher among older people as compared to much younger population (Isangula andMeda, 2017).This calls for strong policies that seek to ensure that the older population are well cared for within rural PHC facilities in their final years of life. While aged care institutions are the cornerstone of Western care, similar institutions are lacking in low-income rural African communities. Consequently, older people in rural settings, mostly uneducated, uninsured, unable to work and often charged with the care of grandchildren, continue to rely on sons and daughters (if any) and neighbors to meet their daily socioeconomic needs (Sanga, 2013; Musa, 2016; United Republic of Tanzania, 2007; UNFPA, 2009). This dependency often contributes to persistent limited access to quality nutrition and medical care among the older population when family members lack the financial capacity to support them. This brings us the question of how better we can, as a country, care for our aging population as part of ensuring they enjoy their final years of life. This paper examines the challenges faced by the older population in a low-income rural community of Shinyanga in relation to access to the much-needed palliative care

Using theories and models for operationalization of patient trust in doctors in chronic disease response in low income Africa: ‘Best Fit Approach’

Background: Recent evidence suggest that improved patient trust in doctors can facilitate their healthcare seeking, adherence and continuity with care. With the growing burden of chronic disease in low income Africa (LIA) characterized by challenges of poor patient healthcare seeking, non-adherence and poor continuity with care, trust forms an important entry point for addressing these challenges. However, the topic of trust has generally received weaker attention among researchers in LIA contexts. To date, there has been no attempts to generate a clear guide for theory-driven inquiries as a means of operationalization of trust as a public health lens for chronic disease response in LIA. Objective: This paper revisits the ‘Best fit approach’, a potentially useful but less used strategy to offer a step by step guide for systematically identifying theories and models for theory-driven inquiries of trust in patient-provider relationships in LIA. Methods/Design: The ‘Best fit framework analysis’ approach is revisited as a potentially useful in systematically identifying ‘best fit’ theories and models of trust to aid theory-driven inquiries. The paper proposes a step by step guide on how to gather theories and models, use thematic analysis approach for coding of themes from selected theoretical literature and lastly, generating an interview guide for theory-driven research in LIA. Conclusion: The review of existing trust theories and models may facilitate generating useful constructs for developing an interview guide for theory driven research on patient-provider trust in LIA. When data from theory-driven inquiries are analysed, they form an important step in operationalization of trust in therapeutic relationships as a lens for addressing the challenges of chronic diseases in LIA context

Evaluation of Suitability to Mothers of Low Literacy Level of Websites Information on Basics of Baby Bath Using DISCERN Tool

One of the challenges in Newborn care is bathing a baby especially for new parents. Baby bath as part of newborn care is of critical importance for healthier development of a baby. Increasingly, Internet resources have been publishing different information on neonatal care complementing the traditional sources. Internet information is readily available and involve no or minimal cost as far as medical costs are concerns thus new parents with access, may use internet as the main source of baby care information. The purpose of this paper is to evaluate the suitability to mothers of low literacy level, of baby bathing information published on websites using a DISCERN tool

Leveraging AI and Machine Learning to Develop and Evaluate a Contextualized User-Friendly Cough Audio Classifier for Detecting Respiratory Diseases: Protocol for a Diagnostic Study in Rural Tanzania

Background: Respiratory diseases, including active tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD), constitute substantial global health challenges, necessitating timely and accurate diagnosis for effective treatment and management. Objective: This research seeks to develop and evaluate a noninvasive user-friendly artificial intelligence (AI)–powered cough audio classifier for detecting these respiratory conditions in rural Tanzania. Methods: This is a nonexperimental cross-sectional research with the primary objective of collection and analysis of cough sounds from patients with active TB, asthma, and COPD in outpatient clinics to generate and evaluate a noninvasive cough audio classifier. Specialized cough sound recording devices, designed to be nonintrusive and user-friendly, will facilitate the collection of diverse cough sound samples from patients attending outpatient clinics in 20 health care facilities in the Shinyanga region. The collected cough sound data will undergo rigorous analysis, using advanced AI signal processing and machine learning techniques. By comparing acoustic features and patterns associated with TB, asthma, and COPD, a robust algorithm capable of automated disease discrimination will be generated facilitating the development of a smartphone-based cough sound classifier. The classifier will be evaluated against the calculated reference standards including clinical assessments, sputum smear, GeneXpert, chest x-ray, culture and sensitivity, spirometry and peak expiratory flow, and sensitivity and predictive values. Results: This research represents a vital step toward enhancing the diagnostic capabilities available in outpatient clinics, with the potential to revolutionize the field of respiratory disease diagnosis. Findings from the 4 phases of the study will be presented as descriptions supported by relevant images, tables, and figures. The anticipated outcome of this research is the creation of a reliable, noninvasive diagnostic cough classifier that empowers health care professionals and patients themselves to identify and differentiate these respiratory diseases based on cough sound patterns. Conclusions: Cough sound classifiers use advanced technology for early detection and management of respiratory conditions, offering a less invasive and more efficient alternative to traditional diagnostics. This technology promises to ease public health burdens, improve patient outcomes, and enhance health care access in under-resourced areas, potentially transforming respiratory disease management globally

A qualitative exploration of nurses’ and midwives’ experiences in designated COVID-19 healthcare facilities in rural and urban Tanzania

Background: Frontline healthcare providers, particularly nurses and midwives, are at higher risk of COVID-19 infection due to frequent patient contact. However, studies examining their experiences, particularly in low-income countries like Tanzania, are limited. Objective: This study aimed to explore the experiences of nurses and midwives providing care in COVID-19-designated healthcare facilities in selected regions of Tanzania. Methods: A qualitative descriptive approach was used to investigate the experiences of nurses and midwives in COVID-19 care. In-depth interviews were conducted with 20 purposefully selected participants from Dar es Salaam, Shinyanga, and Pwani regions. Data were coded with NVivo 12 software and analyzed using a descriptive phenomenology approach. Results: Nurses and midwives in urban areas reported managing more patients and experiencing more deaths than peers in rural settings. Urban and rural participants demonstrated strong knowledge of COVID-19, including its symptoms, management, and preventive measures. Selection for COVID-19 care was based on Ministry of Health guidelines, prioritizing leadership and emergency care experience. Their roles included patient isolation, routine and specialized care, psychological support, health education, and post-mortem care. Despite this, most nurses and midwives reported feeling underprepared due to insufficient training, a lack of personal protective equipment, and limited medical supplies. Additionally, no risk allowances were provided. Nurses and midwives experienced key challenges such as patient stigmatization, abandonment by families, deaths resulting from oxygen shortages, burnout, and personal infection. Nurses and midwives recommended strengthening the healthcare system, providing ongoing training, offering risk allowances, and promoting community education and sensitization to improve future pandemic preparedness. Conclusion: Nurses\u27 and midwives\u27 experiences in COVID-19 care facilities were surrounded by inadequate preparations, with health system deficiencies and societal fears significantly impacting their ability to provide effective care. Strengthening health sector readiness, including training and resource allocation, is essential for future pandemic and disaster response efforts

Manual Qualitative Data Coding Using MS Word for Students and Early Career Researchers in Resource-Constrained Settings

In recent years, the field of qualitative data collection, management, and analysis has undergone significant evolution, with researchers worldwide increasingly leveraging technological advancements to streamline and simplify their practices. Despite the advantages of using qualitative data coding software, several challenges persist, particularly in resource-constrained settings. Issues such as the high cost of software licenses, the time required to learn and use these tools, and the complexity of advanced features often hinder researchers, especially students and early career researchers in low-income contexts, and contribute to the generation of poor-quality research evidence. This paper aims to provide a simplified, step-by-step guide to manual qualitative data coding using Microsoft Word, a widely accessible tool in low-income contexts. It is designed to support students and early-career researchers in low-income settings, helping them to conduct effective qualitative data management and analysis without the need for expensive software. We provide a five-step detailed guide for qualitative data coding using Microsoft Word, based on a practical example from previous research on maternal and child health in rural Tanzania. We also present a hypothetical example of a student research study focusing on the drivers behind pursuing a Bachelor of Science in Nursing degree. The process begins with examining the research objectives and questions to develop preliminary themes and sub-themes, identifying relevant data sources within study interview guides, and creating guided transcription and coding templates tailored to each interview guide, followed by data coding by integrating interview data into a structured template. Practical insights are provided on transforming coded data into meaningful interpretations and analyses. This systematic approach aims to facilitate effective qualitative data management and analysis using accessible tools like Microsoft Word, thereby supporting students and early career researchers in conducting small-scale studies effectively

Patient trust in doctors in rural Tanzania: meanings, factors and benefits in the context of NCDs and hypertension care

Noncommunicable diseases (NCDs) are becoming a major public health challenge in low-income countries. Different strategies have been implemented to alleviate the burden of NCDs, but service uptake, compliance and continuing engagement with care remain suboptimal. This thesis investigated patient trust in doctors to establish whether it could form part of the NCD response in low-income African countries. To date, most studies on this issue have been conducted in high-income countries. This thesis provides much needed evidence around trust by exploring: the meaning of patient trust in doctors; what factors shape trust; and whether trust matters in hypertension care in rural Tanzania. Semi-structured interviews were conducted in Swahili with 36 patients and eight providers. Participants were drawn from Western and traditional healing practices. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes. The findings show that participants’ understanding of trust related to: patient expectations of a doctor before an encounter, patient satisfaction with the doctors’ actions and behaviours during encounters and their post-encounter satisfaction with health outcomes associated with the doctor’s treatment. Factors shaping trust in this rural Tanzanian context can be classified as patient, provider and health system factors. Novel factors identified were patients’ faith in medications, patients’ expectations of hypertension cure and the interplay between Western and traditional systems. Participants suggested that trust mattered in hypertension care in rural Tanzania because of its benefits in facilitating patient healthcare seeking, disclosure, adherence, return for subsequent hospital care, and reduced financial burden. Trust also matters because it benefited doctors by increasing their reputation and work morale, and benefited hospitals by improving their reputation and income. The interviews also revealed a range of potential disadvantages of trust, including increased patients’ vulnerability to malpractice, inflated self-pride among doctors and increased workload. This thesis establishes the value of improving patient trust in doctors as a means of increasing patient healthcare service uptake, adherence and continuity with hospital care for NCD response. The thesis offers context-specific considerations, and practice and policy recommendations for developing strategies to improve patient trust in doctors in low-income African countries