Perceived unfairness in working conditions: The case of public health services in Tanzania

The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions. The study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs) and in-depth interviews (IDIs) with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania. The article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions. The article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation, economic reforms, decentralisation and emerging democratic sentiments. Such a historic contextualisation enhances our understanding of the strong sentiments of unfairness revealed in this study and assists us in considering potential ways forward

Male condom use in Tanzania: results from a national survey.

OBJECTIVE: To determine factors associated with male condom use in Tanzania. METHODS: Data from the 1996 Tanzania Demographic and Health Survey (TDHS) was used. In this survey, a national representative sample of sexually active men (N=1898) and women (N=7027) were interviewed to obtain information about potential predictors of sexual practices and condom use. RESULTS: Two hundred and ninety (4.1%) women and 288 (15.2%) men had used condoms during their last sexual encounter. Men aged 20-24 years and women aged 15-19 years reported the highest rate of condom use. In both men and women, condom use increased with increasing level of education. Residents of large urban centers were more likely to have used condoms among both women [adjusted OR=1.8, 95% CI=1.2-2.8] and men (adjusted O=2.0, 95% CI=1.3-3.1). Condom use was significantly increased among women (adjusted OR=6.2, 95% CI=4.4-8.8) and men [adjusted OR-5.9, 95% CI=3.2-8.8) practising high-risk sexual behaviour. Similarly, condom use was significantly increased among men who were never married and in those who had ever tested for AIDS. CONCLUSIONS: Condom promotion activities have been less successful in Tanzania. Additional efforts to increase condom acceptability and use are urgently needed

Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey.

We conducted this study to determine the factors associated with high-risk sexual behaviour and condom use among men and women who participated in the 1996 Tanzania Demographic and Health Survey (TDHS); and to assess changes in sexual behaviour between 1991/92 and 1996 TDHS. Respondents were regarded to have practised high-risk sexual behaviour if they were married or cohabiting and had other regular or non-regular sexual partners; or if they were unmarried and had non-regular partners or multiple regular partners. About 8% of women and 29% of men practised high-risk sexual behaviour. High-risk sexual behaviour was common among younger men and women, and decreased with increasing level of education in women. Respondents who were unmarried, Muslims and those who perceived themselves at increased risk of HIV/AIDS were more likely to practise high-risk sexual behaviour. About 4% of women and 15% of men reported to have used condoms during their last sexual encounter. Condom users were significantly more likely to practise high-risk sexual behaviour. Overall, no major changes in sexual behaviour and condom use were observed during the period between the two surveys. Predictors of high-risk sexual behaviour and condom use identified in this report provide valuable information that can be used to design targeted HIV/AIDS interventions in Tanzania

Challenges to the implementation of health sector decentralization in Tanzania : experiences from Kongwa district council

Background: During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective: This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design: The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results: The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers' accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion: The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process